Liu Hailei, Ehdaie Ashkan, Cingolani Eugenio, Ramireddy Archana, Braunstein Eric D, Wang Xunzhang, Chugh Sumeet S, Shehata Michael M
Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA.
Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
J Cardiovasc Electrophysiol. 2025 Aug;36(8):1817-1825. doi: 10.1111/jce.16738. Epub 2025 May 28.
Various methods have been used to identify substrate of persistent atrial fibrillation (PeAF) including complex fractionated atrial electrograms (CFAEs), electrogram dispersion, and low-voltage areas (LVAs). This study aims to investigate their relationship and changes following ablation.
Consecutive patients with PeAF undergoing catheter ablation were prospectively recruited. High-density left atrial mapping was employed. Repeat mapping was performed after pulmonary vein and posterior wall isolation (PVI + PWI) if atrial fibrillation persisted. Dispersion tags were automatically annotated using a commercially available artificial intelligence system. A total of 32 patients (mean age 64.8 ± 9.7 years, 26 male) were included. In CFAE regions, 93.1 ± 7.5% of the surface had voltage > 0.5 mV, compared to only 17.5 ± 24.5% in the non-CFAE regions. Nearly all dispersion tags (99.3 ± 1.6%) were located within CFAE regions. Postablation mapping (N = 24) revealed a reduction in both CFAE and dispersion tags, prolongation of atrial cycle length, and de-escalation of CFAE sub-types, even in areas remote from ablation targets. During a median follow-up period of 9.0 ± 1.9 months, among the nine patients with CFAE de-escalations across all five regions, only one (11.1%) experienced recurrence. In contrast, eight out of the remaining 15 patients (53.3%) experienced recurrence (p = 0.039).
Dispersion is associated with CFAEs, predominantly reflecting areas of normal voltage. Regional reductions in CFAE and dispersion burden may occur outside of the directly targeted ablation areas. Post-procedural de-escalation of electrograms across the left atrium might suggest a potential indicator for PVI + PWI responders; however, further studies are warranted.
已采用多种方法来识别持续性房颤（PeAF）的基质，包括复杂碎裂心房电图（CFAE）、电图离散度和低电压区（LVA）。本研究旨在探讨它们之间的关系以及消融后的变化。
前瞻性纳入连续接受导管消融的PeAF患者。采用高密度左心房标测。如果房颤持续，则在肺静脉和后壁隔离（PVI + PWI）后进行重复标测。使用市售人工智能系统自动标注离散度标签。共纳入32例患者（平均年龄64.8±9.7岁，男性26例）。在CFAE区域，93.1±7.5%的表面电压>0.5 mV，而非CFAE区域仅为17.5±24.5%。几乎所有离散度标签（99.3±1.6%）都位于CFAE区域内。消融后标测（N = 24）显示，即使在远离消融靶点的区域，CFAE和离散度标签均减少，心房周期长度延长，且CFAE亚型降级。在9.0±1.9个月的中位随访期内，在所有五个区域CFAE降级的9例患者中，仅1例（11.1%）复发。相比之下，其余15例患者中有8例（53.3%）复发（p = 0.039）。
离散度与CFAE相关，主要反映正常电压区域。CFAE和离散度负荷的区域减少可能发生在直接靶向消融区域之外。左心房电图术后降级可能提示PVI + PWI反应者的潜在指标；然而，仍需进一步研究。
