Sekihara Takayuki, Oka Takafumi, Ozu Kentaro, Sakata Yasushi
Department of Cardiovascular Medicine Osaka University Graduate School of Medicine Osaka Japan.
J Arrhythm. 2023 Dec 1;40(1):90-99. doi: 10.1002/joa3.12971. eCollection 2024 Feb.
The clinical significance of left atrial local electrogram fractionation after restoration of sinus rhythm in patients with atrial fibrillation (AF) has not been elucidated.
We evaluated ultrahigh-resolution maps of the left atrium (LA) during RA pacing acquired after pulmonary vein isolation in 40 patients with AF. The association between low-voltage area (LVA, <0.5 mV), fractionated electrogram area (FEA, the highlighted area with LUMIPOINT™ Complex Activation), the interval from onset of LA activation to wavefront collision at the mitral isthmus (LA activation time), and wave propagation velocity (WPV) was evaluated quantitatively.
The total LVA, total FEA with ≥5.0 peaks or ≥7.0 peaks were 7.0 ± 7.9 cm, 15.9 ± 12.9 cm, and 5.2 ± 7.5 cm, respectively. These areas were predominantly observed in the anteroseptal region. Total LVA, total FEA with ≥5.0 peaks, and total FEA with ≥5.0 peaks in the normal voltage area (NVA: ≥0.5 mV) correlated with LA activation time ( = 0.69, 0.75, and 0.71; each < .0001). In the anterior wall, these areas correlated with regional mean WPV ( = -0.75, -0.83, and - 0.55; each < .0001) and the extent of slow conduction area (SCA) with WPV <0.3 m/s ( = 0.89, 0.84, 0.33; < .0001 for LVA and FEA, < .05 for FEA located in NVA). The anterior wall FEA with ≥7.0 peaks and that in the NVA showed a better correlation in predicting anterior wall SCA ( = 0.92 and 0.86, each < .0001).
Quantitative analysis of FEA together with LVA may facilitate the assessment of LA electrical remodeling.
房颤（AF）患者恢复窦性心律后左心房局部电图碎裂的临床意义尚未阐明。
我们评估了40例AF患者肺静脉隔离后右房起搏期间左心房（LA）的超高分辨率图。定量评估了低电压区（LVA，<0.5 mV）、碎裂电图面积（FEA，LUMIPOINT™ 复合激活突出显示的区域）、从LA激动开始到二尖瓣峡部波前碰撞的间隔（LA激动时间）和波传播速度（WPV）之间的关联。
总LVA、≥5.0个波峰或≥7.0个波峰的总FEA分别为7.0±7.9 cm、15.9±12.9 cm和5.2±7.5 cm。这些区域主要见于前间隔区域。总LVA、≥5.0个波峰的总FEA以及正常电压区（NVA：≥0.5 mV）中≥5.0个波峰 的总FEA与LA激动时间相关（r = 0.69、0.75和0.71；P均<0.0001）。在前壁，这些区域与区域平均WPV相关（r = -0.75、-0.83和 -0.55；P均<0.0001）以及WPV<0.3 m/s的缓慢传导区（SCA）范围相关（r = 0.89、0.84、0.33；LVA和FEA的P<0.0001，NVA中FEA的P<0.05）。前壁中≥7.0个波峰的FEA和NVA中的FEA在预测前壁SCA方面显示出更好的相关性（r = 0.92和0.86，P均<0.0001）。
FEA与LVA的定量分析可能有助于评估LA电重构。
