Quah Jing Xian, Jenkins Evan, Dharmaprani Dhani, Tiver Kathryn, Smith Corey, Hecker Teresa, Joseph Majo X, Selvanayagam Joseph B, Tung Matthew, Stanton Tony, Ahmad Waheed, Stoyanov Nik, Lahiri Anandaroop, Chahadi Fahd, Singleton Cameron, Ganesan Anand
College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia.
Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia.
Heart Rhythm O2. 2022 May 16;3(4):335-343. doi: 10.1016/j.hroo.2022.05.007. eCollection 2022 Aug.
Interatrial conduction has been postulated to play an important role in atrial fibrillation (AF). The pathways involved in interatrial conduction during AF remain incompletely defined.
We recently showed physiological assessment of fibrillatory dynamics could be performed using renewal theory, which determines rates of phase singularity formation (λ) and destruction (λ). Using the renewal approach, we aimed to understand the role of the interatrial septum and other electrically coupled regions during AF.
RENEWAL-AF is a prospective multicenter observational study recruiting AF ablation patients (ACTRN 12619001172190). We studied unipolar electrograms obtained from 16 biatrial locations prior to ablation using a 16-electrode Advisor HD Grid catheter. Renewal rate constants λ and λ were calculated, and the relationships between these rate constants in regions of interatrial connectivity were examined.
Forty-one AF patients (28.5% female) were recruited. A positive linear correlation was observed between λ and λ (1) across the interatrial septum (λ r = 0.5, < .001, λ r = 0.45, < .001), (2) in regions connected by the Bachmann bundle (right atrial appendage-left atrial appendage λ r = 0.29, = .001; λ r = 0.2, = .008), and (3) across the inferior interatrial routes (cavotricuspid isthmus-left atrial septum λ r = 0.67, < .001; λ r = 0.55, < .001). Persistent AF status and left atrial volume were found to be important effect modifiers of the degree of interatrial renewal rate statistical correlation.
Our findings support the role of interseptal statistically determined electrical disrelation in sustaining AF. Additionally, renewal theory identified preferential conduction through specific interatrial pathways during fibrillation. These findings may be of importance in identifying clinically significant targets for ablation in AF patients.
心房传导被认为在心房颤动（AF）中起重要作用。房颤期间参与心房传导的通路仍未完全明确。
我们最近表明，可以使用更新理论对颤动动力学进行生理学评估，该理论可确定相奇点形成率（λ）和破坏率（λ）。使用更新方法，我们旨在了解房颤期间房间隔和其他电耦合区域的作用。
RENEWAL-AF是一项前瞻性多中心观察性研究，招募房颤消融患者（澳大利亚新西兰临床试验注册中心编号：12619001172190）。我们使用16电极Advisor HD Grid导管，研究了消融前从16个双心房位置获得的单极电图。计算更新率常数λ和λ，并检查房间连接区域中这些率常数之间的关系。
招募了41例房颤患者（女性占28.5%）。在以下区域观察到λ和λ之间呈正线性相关：（1）整个房间隔（λ相关系数r = 0.5，P <.001，λ相关系数r = 0.45，P <.001）；（2）由巴赫曼束连接的区域（右心耳-左心耳，λ相关系数r = 0.29，P =.001；λ相关系数r = 0.2，P =.008）；（3）整个下房间路径（腔静脉三尖瓣峡部-左心房隔，λ相关系数r = 0.67，P <.001；λ相关系数r = 0.55，P <.001）。持续性房颤状态和左心房容积被发现是房间更新率统计相关性程度的重要效应修饰因素。
我们的研究结果支持房间隔统计学确定的电分离在维持房颤中的作用。此外，更新理论确定了房颤期间通过特定房间路径的优先传导。这些发现可能对确定房颤患者临床上有意义的消融靶点具有重要意义。
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