Ozcan Cevher, Aziz Zaid, Mayer Michael, Deshmukh Amrish, Al Kassem Hatem, Upadhyay Gaurav, Beaser Andrew, Emami Maryam
Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6092, Chicago, IL 60637, USA.
J Interv Card Electrophysiol. 2025 Apr;68(3):635-642. doi: 10.1007/s10840-024-01956-y. Epub 2024 Nov 29.
The atrial electroanatomic substrate is an essential component in the pathogenesis of atrial fibrillation (AF). However, the electrophysiological markers of susceptible atria for AF are not well-characterized. This study aimed to assess atrial conduction indices on surface electrocardiogram (ECG) and intracardiac electrogram (EGM) as predictors of initiation and recurrence of AF after successful ablation.
We studied all consecutive patients who underwent electrophysiological study and catheter ablation for AF (study group) or atrioventricular nodal reentrant tachycardia (AVNRT) (control group) from 2013 to 2018. Atrial conduction indices were measured on ECG and EGM during the electrophysiology study. Clinical data was obtained from the medical record.
A total of 387 patients with AF (mean age 63 years, 31% female) were studied and compared to 94 patents in control group. The initiation of AF was associated with significant prolongation of atrial conduction indices on ECG and EGM (p < 0.05). During a mean follow up of 5 ± 2 years, recurrence of AF (48%) after successful ablation occurred in patients with prolonged P wave duration, left atrial (LA) conduction interval, proximal to distal coronary sinus (pCS-dCS) interval, and P wave to dCS interval (p < 0.05). Machine learning modeling determined that pCS-dCS interval, QRS duration, and LA duration in leads V1 and II are most impactful conduction indices in association with AF recurrence.
Prolonged atrial conduction intervals, particularly LA (pCS-dCS), indicate susceptible substrate for the onset and the recurrence of AF after ablation. LA conduction indices can facilitate early detection and management of AF.
心房电解剖基质是心房颤动（AF）发病机制的重要组成部分。然而，易发生房颤的心房的电生理标志物尚未得到很好的表征。本研究旨在评估体表心电图（ECG）和心内电图（EGM）上的心房传导指标，作为成功消融后房颤起始和复发的预测指标。
我们研究了2013年至2018年期间所有连续接受房颤电生理检查和导管消融的患者（研究组）或房室结折返性心动过速（AVNRT）患者（对照组）。在电生理检查期间，在ECG和EGM上测量心房传导指标。临床数据从病历中获取。
共研究了387例房颤患者（平均年龄63岁，31%为女性），并与对照组的94例患者进行了比较。房颤的起始与ECG和EGM上心房传导指标的显著延长相关（p<0.05）。在平均5±2年的随访期间，成功消融后房颤复发（48%）发生在P波时限、左心房（LA）传导间期、冠状窦近端至远端（pCS-dCS）间期以及P波至dCS间期延长的患者中（p<0.05）。机器学习模型确定，pCS-dCS间期、QRS时限以及V1和II导联的LA时限是与房颤复发相关的最具影响力的传导指标。
延长的心房传导间期，尤其是LA（pCS-dCS），表明消融后房颤发作和复发的易损基质。LA传导指标有助于房颤的早期检测和管理。
