High-density mapping of atrial fibrillation in humans: relationship between high-frequency activation and electrogram fractionation

Introduction: Sites of complex fractionated atrial electrograms (CFAE) and dominant frequency (DF) have been implicated in maintaining atrial fibrillation (AF); however, their relationship is poorly understood. Methods and Results: Twenty patients underwent biatrial high‐density contact mapping (507 ± 150 points/patient) during AF. CFAE were characterized using software to quantify electrogram complexity (CFE‐mean). Spectral analysis determined the frequency with greatest power and sites of high DF with a frequency gradient. CFE‐mean was higher (less fractionated) for right compared with left atria (P < 0.001) and in paroxysmal compared with persistent AF (P < 0.001). DF was lower for right compared with left atria (P = 0.02) and in paroxysmal compared with persistent AF (P < 0.001). There was significant regional variation in DF in paroxysmal (P < 0.001) but not persistent AF. Highest DF points clustered together with 5.2 ± 1.7 clusters/patient. Correlation between CFE‐mean and DF was poor on a point‐by‐point basis (r =?0.17, P < 0.001), but moderate on an individual basis (r =?0.50, P = 0.03). Exploration of their spatial relationship demonstrated CFAE areas in close proximity (median 5 mm, IQR 2–10) to high DF sites; within 10 mm in 80% and 10–20 mm in 10%. Simultaneous activation mapping at these sites further supports this observation. Conclusion: Greater fractionation and higher DF are seen in persistent AF and left atria during AF. Preferential areas of high DF are observed in paroxysmal but not persistent AF. CFAE and DF correlate within an individual but not point‐by‐point. Exploration of their spatial relationship demonstrates CFAE in areas adjacent to high DF, and this is supported by activation mapping at these sites.     

Spectral profiles of complex fractionated atrial electrograms are different in longstanding and acute onset atrial fibrillation atrial electrogram spectra

Spectral Profiles of CFAE. Background: Spectral analysis of complex fractionated atrial electrograms (CFAE) may be useful for gaining insight into mechanisms underlying paroxysmal and longstanding atrial fibrillation (AF). The commonly used dominant frequency (DF) measurement has limitations. Method: CFAE recordings were acquired from outside the 4 pulmonary vein ostia and at 2 left atrial free wall sites in 10 paroxysmal and 10 persistent AF patients. Two consecutive 8s‐series were analyzed from recordings >16s in duration. Power spectra were computed for each 8s‐series in the range 3–12 Hz and normalized. The mean and standard deviation of normalized power spectra (MPS and SPS, respectively) were compared for paroxysmal versus persistent CFAE. Also, the DF and its peak amplitude (ADF) were compared for pulmonary vein sites only. Power spectra were computed using ensemble average and Fourier methods. Results: No significant changes occurred in any parameter from the first to second recording sequence. For both sequences, MPS and SPS were significantly greater, and DF and ADF were significantly less, in paroxysmals versus persistents. The MPS and ADF measurements from ensemble spectra produced the most significant differences in paroxysmals versus persistents (P < 0.0001). DF differences were less significant, which can be attributed to the relatively high variability of DF in paroxysmals. The MPS was correlated to the duration of uninterrupted persistent AF prior to electrophysiologic study (P = 0.01), and to left atrial volume for all AF (P < 0.05). Conclusions: The MPS and ADF measurements introduced in this study are probably superior to DF for discerning power spectral differences in paroxysmal versus longstanding CFAE. (J Cardiovasc Electrophysiol, Vol. 23, pp. 971‐979, September 2012)     

Understanding and interpreting dominant frequency analysis of AF electrograms

Dominant frequency analysis of atrial electrograms has been used to understand the pathophysiology of atrial fibrillation (AF). Although dominant frequency is an effective tool to estimate activation rate during AF, other factors besides activation rate may alter the results. Therefore, an adequate conceptual understanding of frequency domain analysis is required to properly use this technique and interpret the results. This review, while avoiding the use of formulas and equations, aims to explain fundamental theory of how signals can be decomposed into sine waves and how these sine waves relate to the activation rate detected from the electrograms. Through a series of examples and illustrations this relationship can be easily conceptualized. This will in turn allow the strengths and limitations of dominant frequency analysis to be better understood and improve its applicability to potential clinical usages.     

Technical considerations for dominant frequency analysis

Introduction : Dominant frequency (DF) analysis of atrial electrograms has been used to characterize atrial fibrillation (AF). The aim of this study was to explore technical issues that may affect the estimation of local activation rate during AF using DF analysis.
Methods and Results: Epicardial atrial electrograms recorded during AF from 10 dogs were used to evaluate the effects of unipolar versus bipolar recordings, bipolar electrode spacing, postrecording processing, far field ventricular depolarizations, ventricular template subtraction, and signal duration on DF analysis. Simulated electrograms were used to evaluate the effect of far field ventricular depolarizations and signal-to-noise ratio. DFs were compared with activation rates obtained by manual marking and the reproducibility of the DFs was evaluated. Bipolar electrograms were found to be preferable to unipolar electrograms. Preprocessing was a necessary step for bipolar signals, but also aided analysis of unipolar recordings. Ventricular far field depolarizations significantly affected DFs. Ventricular template subtraction helped DF analysis in signals with both minimal and significant ventricular components. A recording duration above 2 seconds was required for reliable DF measurements. Signal-to-noise ratios below 13 dB could also affect DF, particularly for signals with significant amplitude and frequency variation.
Conclusions: Various factors affect DF analysis. Proper interpretation of DF analysis requires careful evaluation of the AF signals and robust processing techniques.     

Time- and frequency-domain characteristics of atrial electrograms during sinus rhythm and atrial fibrillation

Ablation and Spectral Characteristics of Fibrillation. Background: Complex fractionated atrial electrograms (CFAE) have been considered to be helpful during catheter ablation of atrial fibrillation (AF). The purpose of this study was to analyze the characteristics of CFAEs recorded during sinus rhythm (SR) and AF, and to determine their relationship to perpetuation of AF and clinical outcome. Methods and Results: Antral pulmonary vein isolation (APVI) was performed in 34 consecutive patients (age = 59 ± 10 years) with paroxysmal AF who presented in SR. Time‐ and frequency‐domain characteristics of electrograms recorded from the same sites in the coronary sinus (CS) were analyzed during SR and AF, before and during isoproterenol infusion. There was a modest correlation in fractionation index (FI: change in the direction of depolarization, r = 0.40, P = 0.001) and complexity index (CI: change in the polarity of depolarization, r = 0.41, P = 0.001), but not in the dominant frequency (DF) between SR and AF. There was no relationship between the DF and CI or FI during AF. Isoproterenol was associated with an increase in DF during AF (6.6 ± 0.9 vs 5.1 ± 0.6 Hz, P < 0.001) but had no effect on CI or FI (P = 0.6). A higher CI (58.3 ± 21.0/s vs 38.0 ± 21.0/s, P < 0.01), and FI (123.5 ± 44.8/s vs 75.6 ± 44.6/s, P < 0.01) during AF were associated with a lower likelihood of termination of AF during APVI and a higher probability of recurrent AF after ablation. Ratio of FI during AF to SR was also higher when AF persisted than terminated after APVI (29.7 ± 12.4 vs 19.1 ± 9.7, P = 0.002). However, time‐ or frequency‐domain parameters during SR were not predictive of termination or clinical outcome. Conclusions: Structural and functional properties of the atrial myocardium during AF contribute to electrogram complexity, which may indicate the presence of extra‐PV mechanisms of AF that are not eliminated by APVI. Mapping of complex electrograms in SR is not likely to be sufficient to identify drivers of AF. (J Cardiovasc Electrophysiol, Vol. 22, pp. 851‐857, August 2011)     

Relationship between complex fractionated electrograms (CFE) and dominant frequency (DF) sites and prospective assessment of adding DF-guided ablation to pulmonary vein isolation in persistent atrial fibrillation (AF)

Dominant Frequency Mapping and Ablation . Background: Sites of high DF are potential targets for AF ablation, but it is unknown if addition of DF ablation can improve procedural outcome. Objectives: We sought to (1) examine the relationship between DF sites and complex fractionated electrograms (CFE) and (2) prospectively assess the long‐term outcome of adding DF ablation to pulmonary vein antral isolation (PVAI) for persistent AF. Methods: First, 20 patients with persistent AF who underwent previous CFE‐guided ablation and who had AF terminate during ablation were studied retrospectively (group I). Bipolar, 8‐second electrograms were collected by a circular catheter (288 ± 86 points/map). The EnSite NavX system allows for automated display of both CFE and DF maps. Electrograms with cycle length <120 ms were considered CFE and were compared to DF sites > 8 Hz (direct inverse relationship). Sites of AF termination were related to CFE and DF sites. Based on these observations, 30 different patients (group II) with persistent AF prospectively underwent DF‐guided ablation plus PVAI. They were followed every 3 months for 1 year (visit, Holter, ECG). These patients were compared to case‐matched controls undergoing PVAI alone (group III). Results: In group I, there was a significant, inverse correlation between DF and CFE values at each point (r =–0.24, P < 0.001). DF surface area was less than CFE area (27 ± 5 cm² vs 34 ± 4 cm², P = 0.03). CFE sites overlapped 48 ± 27% with the DF surface area. Nonoverlapping CFE sites were contiguous to DF sites. AF termination occurred where DF and CFE overlapped, and at these sites, DF was always greater than the mean DF for the map. In group II, all DF sites above the mean value were prospectively ablated during AF. AF termination was noted in only 2/30 (7%) patients. After DF ablation, PVAI was performed and termination increased to 4/30 patients (14%). At 1 year, freedom from atrial arrhythmia > 30 seconds occurred in 57% of DF+PVAI compared to 60% in patients receiving PVAI alone (P = 0.18). Conclusions: DF and CFE regions overlap only about 50%. AF termination retrospectively occurred on overlapping CFE/DF sites where DF was above the mean. However, prospective ablation of DF sites plus PVAI resulted in low AF termination rates, and did not improve 1 year success over PVAI alone. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1309‐1316, December 2011)     

左心房高主频及连续碎裂电位电生理特点与持续性心房颤动射频消融临床疗效的关系

目的 探讨左心房（LA）高主频（HDF）及连续碎裂电位（CCFAE）的电生理特点对持续性心房颤动（AF）射频消融术疗效的影响.方法 入选宁波市第一人民医院2011年10月至2012年6月间,至少经2种抗心律失常药物治疗无效且有症状的持续性AF患者42例,在三维标测系统NavX指导下首先行环肺静脉电隔离术（PVI）,对未转复窦性心律（窦律）者继续行LA内CCFAE及HDF（最高频率位点与邻近点频率相差≥20％,DF值≥7 Hz）标测,消融终点：转为窦律且不能被诱发或消除所有CCFAE,对仍维持AF者,行直流电复律;如转为规则的房性心动过速（房速）,明确其电生理机制后进行消融终止.根据随访结果,分为PVI联合CCFAE消融窦律维持组22例（组1）与复发组16例（组2）,其中4例患者在PVI中恢复窦律,回顾性分析影响预后的因素.结果 继续CCFAE消融后15例转复窦律（10例直接转复）,5例房速经消融终止,18例接受直流电复律.随访（1.4±0.2）年,接受PVI联合CCFAE消融22例（57.9％,组1）维持窦律,两组临床特点为LA内CCFAE均值（CCFAE-mean）、CCFAE最大值（CCFAE-max）、CCFAE/LA面积比差异无统计学意义（P＞0.05）,组2平均LA内HDF值（HDF-mean）、HDF最大值（HDF-max）、HDF/LA面积比、CCFAE区域的外周（＞2 cm） HDF、CCFAE-max至HDF-max距离大于组1（P＜0.05）,组1邻近（≤2 cm） HDF的CCFAE区域数量多于组2（P＜0.05）,组1HDF-max位点频谱下降值明显高于组2（P＜0.05）.HDF/LA面积比（OR=2.19,95％CI 1.22～3.92,P＜0.05）、外周HDF的CCFAE区域（OR=0.38,95％CI0.15～0.98,P＜0.05）为射频消融复发的两个独立预测因素.结论 LA内HDF分布及CCFAE与HDF空间关系可能与持续性AF射频消融术后维持有关,提示邻近HDF的CCFAE基质改良策略有效的同时,可减少消融面积.     

Electrophysiological characteristics of complex fractionated electrograms and high frequency activity in atrial fibrillation

Background

It is unclear whether atrial substrate with complex fractionated electrograms (CFAEs) is related to arrhythmogenesis. This study aimed to investigate the electrophysiology in CFAE and high dominant frequency (DF) areas.

Methods and results

Atrial fibrillation (AF) was induced by rapid atrial pacing in heart failure (HF) rabbits (4 weeks after coronary artery ligation). Real-time substrate mapping, multielectrode array, and monophasic action potential recordings were used to study areas of CFAE and DF. Conventional microelectrode and western blot were used to record the action potentials (APs) and protein expression in isolated tissue preparations. CFAE site with high DF had the most depolarized resting membrane potential, highest incidence of early and delayed afterdepolarizations, and steepest maxima slope of 90% of AP duration (APD₉₀) restitution curve (RC) compared to CFAE site with low DF or non-CFAE sites. CFAE site with high DF exhibited the slowest conduction velocity and shortest wavelength than the other areas. Upregulation of the Na⁺–Ca^2 + exchanger (NCX), apamin-sensitive small-conductance Ca^2 +-activated K⁺ channel type 2 (SK2) and sarcoplasmic reticulum Ca^2 +-ATPase, and downregulation of the Kir2.1 were found at CFAE site with high DF compared to that observed in the 3 other areas. Inhibition of the NCX and SK channels prolonged the APD₉₀, flattened the maximum slope of RC, and suppressed AF.

Conclusions

CFAE site with high DF had an arrhythmogenic property differing significantly from the other areas of LA in an HF rabbit model, which may contribute to the genesis of AF.     

Autonomic mechanism to explain complex fractionated atrial electrograms (CFAE)

Objective:  To simulate complex fractionated atrial electrograms (CFAE) during sustained atrial fibrillation (AF) in experimental animals.
Background:  The mechanism(s) underlying CFAE has not been fully elucidated.
Methods:  Twenty-two dogs were subjected to a right and/or left thoracotomy. A gauze patch soaked with acetylcholine (ACh) was placed on the right atrial appendage (RAA) to induce sustained AF. During AF, varying concentrations of ACh (1, 10, 100 mM) were "painted" on the RA where electrograms showed regular organized activity. In another six dogs, anterior right ganglionated plexi (ARGP) near the sino-atrial node and inferior right GP (IRGP) at the junction of inferior vena cava and atria were sequentially ablated. In five dogs, ACh was injected into ARGP to induce CFAE.
Results:  During sustained AF, local "painting" with ACh 1 mM and 10 mM induced intermittent CFAE in 1 of 11 and 10 of 11 dogs, respectively. With 100 mM ACh, all 11 showed CFAE (two intermittent, nine continuous). In six other dogs, continuous CFAE induced by topical application of 100 mM ACh were markedly attenuated by ARGP + IRGP ablation. In another five of five dogs, ACh injection into ARGP induced a gradient of CFAE with the continuous CFAE always occurring near the ARGP and CFAE also occurring at left pulmonary vein-atrial junctions. During ARGP ablation, AF was terminated in all five dogs immediately after regularization of the rotor-like electrograms or continuous CFAE.
Conclusions:  This study demonstrates an autonomic basis for CFAE formation, suggesting that graded hyperactive states of the autonomic nervous system (ANS) may induce various types of CFAE observed clinically.     

老年对慢性心房颤动患者左房复杂碎裂电位的影响

目的 评价老年对非瓣膜病心房颤动（简称房颤）患者左房复杂碎裂电位（CFAEs）的影响。方法 前瞻性入选116例行导管消融的慢性房颤患者。 以60岁为界,分为老年组（n=48）与非老年组（n=68）。 在CARTO系统指导下记录局部稳定的心内膜电图。 应用CARTO系统内置的CFAEs分析软件进行分析。 以间期置信水平（ICL）来评估CFAEs的特点。 CFAEs指数定义为 ICL≥7 区域的面积与左房表面积的比值。 将左房分为前壁、后壁、顶部、下壁、外侧壁、间隔六个部分,评价CFAEs在左房不同位置的分布特征。 结果 老年组男性患者比例显著低于非老年组,合并高血压、脑卒中的比例显著高于非老年组（P均〈0. 05）。 老年组最大ICL显著大于非老年组[（16.7±2.0） vs （15.7±2.2）,P=0. 014）],老年组CFAEs指数显著高于非老年组[（60. 4%±22.9% ） vs （48. 6%±22. 3% ）,P=0. 007）]。 老年组左房前壁、间隔的CFAEs的分布比例显著大于非老年组。 年龄与CFAEs指数呈正相关（r=0. 244, P=0. 008）。 结论 老年慢性房颤具有广泛的 CFAEs。     

肺静脉电隔离术联合碎裂电位消融治疗持续性房颤疗效观察

目的：观察肺静脉电隔离术（ pulmonary vein isolation , PVI ）联合碎裂电位（ complex fractionated atrial electrograms , CFAE）消融对持续性房颤的疗效。方法对比观察23名于本院行房颤射频消融术的持续性房颤患者,所有患者均行PVI及左房顶部线性消融,其中12例联合CFAE消融,术后随访1年;观察两组手术时间、X线曝光时间、消融时间、手术并发症、左房大小、左房血栓、一次手术成功率等指标。结果联合CFAE消融组总手术时间（252±35） min、X线曝光时间（42±9．1）min、消融时间（94±11）min,单纯行PVI 组分别为（176±22）min、（34±7．6）min、（63±8）min,联合CFAE消融组手术各时间均明显延长（P＜0．01）;两组手术并发症、对左房大小及左房血栓的影响比较差异均无统计学意义;联合CFAE消融组一次手术成功率（75％）明显高于单纯行PVI组（64％）（ P＜0．05）。结论 PVI联合CFAE消融治疗持续性房颤虽增加手术、消融及X线曝光时间,但并不会提高并发症发生率,可提高房颤消融的一次手术成功率。     

Complex fractionated electrogram distribution and temporal stability in patients undergoing atrial fibrillation ablation

Background: Targeting of complex fractionated electrograms (CFEs) has been described as an approach for catheter ablation of atrial fibrillation (AF); however, the distribution and temporal stability of CFE regions remain poorly defined.
Methods: In patients with persistent AF referred for ablation, we performed two consecutive left atrial (LA) CFE maps prior to AF ablation. Bipolar electrograms were acquired during AF, and the mean AF cycle length and electrogram voltage were automatically determined at each point. Sites with mean CL ≤120 ms were considered CFE positive. The two maps were then compared qualitatively and quantitatively.
Results: A total of 15 patients (93% male, age 56.1 ± 9.0 years) undergoing AF ablation were studied. The two maps were separated in time by 31 ± 10 minutes. There was no significant difference in the number of CFE-positive regions (12.3 ± 5.2 vs 11.3 ± 4.7; P = 0.06) between the maps. While CFEs were widely distributed within the LA, the PV/left atrial junction (73%) and left atrial appendage (77%) were most often CFE positive. The presence of CFEs at each region was concordant 78% of the time. There was a significant correlation between the two maps (r = 0.35 ± 0.21, range 0.1–0.84; P < 0.001) with a percent difference of 17.5 ± 9.4%.
Conclusions: During persistent AF, most CFE regions are found in the vicinity of the PVs. There is a significant correlation between two CFE maps constructed 31 minutes apart, with 78% concordance of CFE sites.     

不同部位刺激诱发心房颤动时碎裂电位的出现与分布

目的 探讨在心房和肺静脉不同部位行电刺激诱发心房颤动（简称房颤）时碎裂电位（CFAEs）的出现与分布。方法 22只成年健康杂种犬,常规麻醉,气管插管,切断双侧颈迷走神经干,破坏颈交感神经节,建立动物的去自主神经模型。双侧开胸,分别在右心耳、左心耳和四支肺静脉的近、中、远段行电刺激诱发房颤,观察在基础刺激、双侧强迷走刺激两种诱发条件下,房颤发作时CFAEs的分布情况。结果 刺激诱发房颤的部位与CFAEs出现的部位并不完全一致。双侧心房（心耳）及肺静脉口附近是房颤时CFAEs出现的高频部位。当伴有迷走神经刺激时,房颤的诱发率提高,CFAEs的出现频率也随之明显增加。结论 房颤时CFAEs的分布并不局限于心房或肺静脉的某一局部区域,而是在多个部位可同时标测到。迷走刺激条件下标测到CFAEs的频率增加。     

Autonomic mechanism for complex fractionated atrial electrograms: evidence by fast fourier transform analysis

Introduction: The mechanism(s) underlying complex fractionated atrial electrograms (CFAE) is not well understood. We hypothesized that CFAE may be caused by enhanced activity of the intrinsic cardiac autonomic nervous system.
Methods and Results: In 35 anesthetized dogs, via a right or left thoracotomy, sustained atrial fibrillation was induced by local application of acetylcholine (ACh; 10, 100 mM) to the surface of the atrial appendage (AA) or by injection of ACh (10 mM) into the ganglionated plexi (GP). Fast Fourier transform analysis was performed from recordings at AA, atrial sites near the AA, mid portion of the atrium, atrial sites near the GP, and the pulmonary veins. After AF was induced with ACh either by topical application to the AA or by direct injection into the GP, CFAE exhibited a significant gradient of progressively decreasing dominant frequency and incidence of CFAE (CFAE%) from the GP toward distant sites, while regularity index progressively decreased in the opposite direction. Ablation of GP markedly attenuated CFAE and eliminated these gradients.
Conclusions: These results suggest CFAE may result from activation of the intrinsic cardiac autonomic nervous system in these animal models of sustained AF. Ablation of GP attenuates CFAE and eliminates the DF gradient.     

Diagnostic accuracy of a new software for complex fractionated electrograms identification in patients with persistent and permanent atrial fibrillation

Introduction: The elimination of complex fractionated atrial electrograms (CFAEs) has been proposed as a potential target for guiding successful AF substrate ablation. The possibility to efficiently map the atria and rapidly identify CFAEs sites is necessary, before the CFAEs ablation becomes a routine approach. The aims of this study, conducted in patients with persistent and permanent atrial fibrillation (AF), were to analyze by CARTO mapping in the right (RA) and in the left atrium (LA) during AF: (1) the diagnostic accuracy of a new software for CFAEs analysis, (2) the spatial distribution of CFAEs, (3) the regional beat to beat AF intervals (FF). Methods and Results: Twenty‐five consecutive patients (four women, 58.8 ± 11.4 years) undergoing radiofrequency catheter ablation for persistent and permanent AF were enrolled in the study. The CFAE software showed a high sensitivity (90%) and specificity (91%) in the identification of CFAEs, using a specific setting of parameters. The LA had a significantly higher prevalence of CFAEs as compared with the RA (30.5% vs 20.3%, P = 0.016). The CFAEs were mostly present in the septum and in the area of coronary sinus ostium (CS os). The FF intervals were significantly shorter in the LA than in the RA (P < 0.01). Conclusion: CARTO system has a high diagnostic accuracy in the identification of CFAEs. Atrial electrical activity (CFAEs, mean FF intervals) during AF showed a significant spatial inhomogeneity.     

Randomized comparison between pulmonary vein antral isolation versus complex fractionated electrogram ablation for paroxysmal atrial fibrillation

Catheter Ablation of Paroxysmal AF. Introduction: Circumferential pulmonary vein antral isolation (PVAI) and atrial complex fractionated electrograms (CFEs) are both ablative techniques for the treatment of paroxysmal atrial fibrillation (PAF). However, data on the comparative value of these 2 ablation strategies are very limited. Methods and Results: We randomized 118 patients with drug‐refractory PAF to receive PVAI ablation (n = 60) or CFE ablation (n = 58). For CFE group, spontaneous/induced AF was mapped using validated, automated software to guide ablation until all CFE areas were eliminated. For PVAI group, all 4 pulmonary vein antra were electrically isolated as confirmed by circular mapping catheter. Patients with spontaneous/inducible AF after the initial ablation procedure were crossed over to the other arms. After initial ablation procedure, AF persisted/inducible in 24/59 patients (41%), and 34/58 patients (59%) assigned to PVAI and CFE ablation, respectively (P = 0.05). Then 58 patients underwent PVAI + CFE ablation. After 22.6 ± 6.4 months, PVAI ablation group was more likely than CFE ablation group to achieve control of any AF/atrial tachycardia (AT) off drugs (43/60, 72% vs 33/58, 57%, P = 0.075) and lower recurrence rate of AT (11.9% vs 34.5%, P = 0.004). Patients who received CFE ablation alone (38%) had significantly lower overall success rate to achieve control of AF/AT off drugs compared with patients who received PVAI ablation (77%, P = 0.002) alone or PVAI + CFE ablation (69%, P = 0.008) due to higher recurrence rate of AT (50% vs 6% vs 13%, P < 0.01). Conclusions: CFE ablation in PAF patients was associated with higher occurrence rate of postprocedure AT compared with PVAI ablation, whereby making it less likely to be a sole ablation strategy for PAF patients. (J Cardiovasc Electrophysiol, Vol. 22, pp. 973‐981, September 2011)     

心房颤动肺静脉前庭和左房内连续碎裂电位的电生理特点

目的探讨阵发性和持续性心房颤动(简称房颤)患者肺静脉前庭(PVO)和左房(LA)内连续碎裂电位(CFEAs)的电生理特点。方法入选24例药物治疗无效的房颤患者,依房颤节律分为阵发性房颤(PAF)组与持续性房颤(PeAF)组,每组各12例,根据距离肺静脉口远近,将肺静脉分成距肺静脉5～10 mm(Ⅰ区)与10～20 mm(Ⅱ区)两区。在房颤时,应用EnSite NavX标测系统高密度标测PVO和LA,比较两组平均CFE值(碎裂间期)≤70ms的CFAEs的电生理特点。结果①PeAF组LA内径大于PAF组(P<0.05),PAF组LA后壁CFAES分布比例最低,顶部最高,PeAF组前后壁最低,左心耳最高;PAF组PVO较LA高(P<0.05),PeAF组PVO和LA无差异。②两组间总PVO区域连续CFAEs比例无差异,PeAF组LA明显高于PAF组(P<0.05),PAF左下PVO连续CFAEs分布比例高于PeAF(P=0.02),另三支PVO无明显差别。除顶部PAF组连续CFAEs分布高于PeAF组(P=0.02)外,PeAF组下壁、左心耳及二尖瓣环均显著高于PAF组(P均<0.001)。③PAF组各支Ⅰ区连续CFAEs分布高于Ⅱ区(P<0.05),PeAF组左下PVOⅠ区高于Ⅱ区(P<0.05),右上PVOⅡ区高于Ⅰ区(P<0.05),另两支PVO无差异。④PAF组PVO平均CFE明显低于LA(P<0.0001),PeAF组两区域及两组间PVO则无差异;PeAF组LA平均CFE值较低,连续CFAEs数量较多,房颤周长较短。结论 LA电解剖重构在房颤维持中起重要作用,PeAF LA内连续CFAEs分布较PAF广泛,碎裂程度更高,房颤周长较短。PVO绝大多数连续CFAEs位于5～10 mm区域。