de Groot Natasja M S, Kleber Andre, Narayan Sanjiv M, Ciaccio Edward J, Doessel Olaf, Bernus Olivier, Berenfeld Omer, Callans David, Fedorov Vadim, Hummel John, Haissaguerre Michel, Natale Andrea, Trayanova Natalia, Spector Peter, Vigmond Edward, Anter Elad
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, Massachusetts, Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Heart Rhythm. 2024 Nov 17. doi: 10.1016/j.hrthm.2024.11.012.
The international Working Group of the Signal Summit is a consortium of experts in the field of cardiac electrophysiology dedicated to advancing knowledge on understanding and clinical application of signal recording and processing techniques. In 2023, the working group met in Reykjavik, Iceland, and laid the foundation for this manuscript. Atrial fibrillation (AF) is the most common arrhythmia in adults, with a rapidly increasing prevalence worldwide. Despite substantial research efforts, advancements in elucidating the underlying mechanisms of AF have been relatively modest. Since the discovery of pulmonary veins as a frequent trigger region for AF initiation more than 2½ decades ago, advancements in patient care have primarily focused on technologic innovations to improve the safety and efficacy of pulmonary vein isolation (PVI). Several factors may explain the limited scientific progress made. First, whereas AF initiation usually begins with an ectopic beat, the mechanisms of initiation, maintenance, and electrical propagation have not been fully elucidated in humans, largely owing to suboptimal spatiotemporal mapping. Second, underlying structural changes have not been clarified and may involve different types of reentry. Third, inconsistent definitions and terminology regarding fibrillatory characteristics contribute to the challenges of comparing results between studies. Fourth, a growing appreciation for phenotypical differences probably explains the wide range of clinical outcomes to catheter ablation in patients with seemingly similar AF types. Last, restoring sinus rhythm in advanced phenotypic forms of AF is often not feasible or may require extensive ablation with minimal or no positive impact on quality of life. The aims of this international position paper are to provide practical definitions as a foundation for discussing potential mechanisms and mapping results and to propose pathways toward meaningful advancements in AF research, ultimately leading to improved therapies for AF.
信号峰会国际工作组是心脏电生理学领域的专家联盟，致力于推动信号记录与处理技术在理解和临床应用方面的知识进步。2023年，该工作组在冰岛雷克雅未克召开会议，为本文奠定了基础。心房颤动（AF）是成年人中最常见的心律失常，在全球范围内其患病率正在迅速上升。尽管进行了大量研究，但在阐明房颤潜在机制方面取得的进展相对有限。自二十多年半前发现肺静脉是房颤起始的常见触发区域以来，患者护理方面的进展主要集中在技术创新上，以提高肺静脉隔离（PVI）的安全性和有效性。有几个因素可以解释所取得的科学进展有限的原因。首先，虽然房颤通常始于异位搏动，但在人类中，起始、维持和电传导的机制尚未完全阐明，这主要是由于时空映射不理想。其次，潜在的结构变化尚未明确，可能涉及不同类型的折返。第三，关于颤动特征的定义和术语不一致，给比较不同研究结果带来了挑战。第四，对表型差异的认识不断提高，这可能解释了在看似相似的房颤类型患者中，导管消融临床结果差异很大的原因。最后，在晚期表型房颤中恢复窦性心律通常不可行，或者可能需要广泛消融，而对生活质量的积极影响很小或没有。本国际立场文件的目的是提供实用定义，作为讨论潜在机制和映射结果的基础，并提出房颤研究取得有意义进展的途径，最终实现房颤治疗的改善。
