Gagyi Rita B, Szegedi Nándor, Simon Judit, Wijchers Sip, Bhagwandien Rohit, Kong Melissa H, Ruppersberg Peter, Szili-Torok Tamas
Department of Cardiology, Electrophysiology, Erasmus MC, Rotterdam, Netherlands.
Heart and Vascular Center, The Semmelweis University Hospital, Budapest, Hungary.
Front Cardiovasc Med. 2022 Sep 28;9:928384. doi: 10.3389/fcvm.2022.928384. eCollection 2022.
Anatomical variations and characteristics of the left atrium (LA) may have a previously undescribed effect on source locations in atrial fibrillation (AF). This is the first study aiming to investigate the relationship between anatomical characteristics of the LA and non-PV sources detected by electrographic flow (EGF) mapping in patients with persistent AF.
We analyzed cardiac computed tomography (CT) and EGF mapping data in patients who underwent radiofrequency catheter ablation (CA). EGF mapping is a novel method based on Horn-Schunk flow estimation algorithm, used to estimate cardiac action potential flow in the atria that can detect AF sources in patients with persistent AF. By analyzing EGF maps obtained during CA procedures, we localized non-PV sources in the LA.
Thirty patients were included in this study (mean age 62.4 ± 6.8 years). Ten patients had AF sources near the LA ridge, while twenty patients had no leading source (source activity > 26%) near the LA ridge. LA anatomical characteristics, left atrial appendage (LAA) length, and ostial diameter showed no correlation with the presence of a leading source. We documented 19 patients with abutting LAA and left superior pulmonary vein (LSPV) (distance < 2 mm), and 11 patients with non-abutting LAA-LSPV (distance > 2 mm). Three out of 19 patients presented with a leading source near ridge in the abutting LAA-LSPV group, while 7 out of 11 patients presented with a leading source near the ridge in the non-abutting LAA-LSPV group ( = 0.01).
Our data suggests that non-abutting LAA-LSPV is associated with the presence of AF sources near the LA ridge.
左心房（LA）的解剖变异和特征可能对心房颤动（AF）的起源部位有此前未被描述的影响。这是第一项旨在研究持续性AF患者中LA的解剖特征与通过电图流（EGF）标测检测到的非肺静脉（PV）起源之间关系的研究。
我们分析了接受射频导管消融（CA）患者的心脏计算机断层扫描（CT）和EGF标测数据。EGF标测是一种基于Horn-Schunk流估计算法的新方法，用于估计心房中的心脏动作电位流，可检测持续性AF患者的AF起源。通过分析CA手术过程中获得的EGF图，我们在LA中定位了非PV起源。
本研究纳入30例患者（平均年龄62.4±6.8岁）。10例患者的AF起源靠近LA嵴，而20例患者在LA嵴附近没有主导起源（起源活动>26%）。LA的解剖特征、左心耳（LAA）长度和开口直径与主导起源的存在无关。我们记录了19例LAA与左上肺静脉（LSPV）相邻（距离<2mm）的患者和11例LAA-LSPV不相邻（距离>2mm）的患者。19例相邻LAA-LSPV组患者中有3例在嵴附近出现主导起源，而11例不相邻LAA-LSPV组患者中有7例在嵴附近出现主导起源（P = 0.01）。
我们的数据表明，LAA-LSPV不相邻与LA嵴附近AF起源的存在有关。
