Shimojo Masafumi, Inden Yasuya, Yanagisawa Satoshi, Yamauchi Ryota, Hiramatsu Kei, Iwawaki Tomoya, Tachi Masaya, Kondo Shun, Goto Takayuki, Tsuji Yukiomi, Murohara Toyoaki
Department of Cardiovascular Research and Innovation Nagoya University Graduate School of Medicine Nagoya Japan.
Department of Cardiology Nagoya University Graduate School of Medicine Nagoya Japan.
J Arrhythm. 2024 Sep 27;40(6):1389-1399. doi: 10.1002/joa3.13151. eCollection 2024 Dec.
Visualizing the specific regions where atrial fibrillation (AF) is maintained is crucial for effective treatment, but it remains challenging in clinical practice. We aimed to address this challenge by developing a mapping approach focused on the cycle length (CL) and its gradient (CL-gradient).
In 105 patients undergoing initial ablation for persistent AF, pre-ablation CARTOFINDER data were utilized to create maps based on three indicators: (1) CL, the atrial frequency during AF calculated using CARTOFINDER; (2) Short CL, encompassing CLs within 5 ms of the minimum CL; and (3) CL-gradient, the CL range within a 6 mm radius. We evaluated the association between the AF termination through ablation and the measured values and patterns in each map.
AF termination occurred in 17 patients. The AF termination group exhibited the significant large maximum CL-gradient (48.8 ms [interquartile range, 38.6-66.3], <.001) and the short distance between the minimum CL site and the maximum CL-gradient site (15.8 mm, [interquartile range, 6.0-23.2], =.029). Of the 17 AF termination cases, 13 exhibited a CL distribution pattern characterized by a steep CL-gradient near the minimum CL site (SG-MCL), defined as the distance of less than 23.2 mm and the maximum CL-gradient greater than 33.1 ms. In these AF termination cases, SG-MCL was also correlated with the ablation area.
The minimum CL area accompanied by significant CL gradients in the immediate vicinity may play a crucial role in sustaining AF.
可视化心房颤动（AF）维持的特定区域对有效治疗至关重要，但在临床实践中仍然具有挑战性。我们旨在通过开发一种专注于周期长度（CL）及其梯度（CL梯度）的标测方法来应对这一挑战。
在105例接受持续性AF初次消融的患者中，利用消融前的CARTOFINDER数据基于三个指标创建标测图：（1）CL，使用CARTOFINDER计算的AF期间的心房频率；（2）短CL，包括最小CL的5毫秒范围内的CL；（3）CL梯度，6毫米半径内的CL范围。我们评估了通过消融实现的AF终止与每个标测图中的测量值和模式之间的关联。
17例患者发生AF终止。AF终止组表现出显著更大的最大CL梯度（48.8毫秒[四分位间距，38.6 - 66.3]，<.001）以及最小CL位点与最大CL梯度位点之间的短距离（15.8毫米，[四分位间距，6.0 - 23.2]，=.029）。在17例AF终止病例中，13例表现出一种CL分布模式，其特征是在最小CL位点附近有陡峭的CL梯度（SG - MCL），定义为距离小于23.2毫米且最大CL梯度大于33.1毫秒。在这些AF终止病例中，SG - MCL也与消融面积相关。
紧邻区域伴有显著CL梯度的最小CL区域可能在维持AF中起关键作用。
