阵发性心房颤动环肺静脉消融术中出现去迷走效应对疗效的影响

目的观察环肺静脉消融电隔离术治疗阵发性心房颤动(简称房颤),术中出现去迷走效应及消融碎裂电位对疗效的影响。方法对89例阵发性房颤患者行环肺静脉射频消融术治疗,消融终点为肺静脉电隔离,将术中出现去迷走效应及标测到碎裂电位并进行消融的房颤患者列为阳性组,余患者列为阴性组。观察比较两组患者术前、术后1天、3个月、6个月的心率变异性(HRV)指标、左房内径(LAD)、左室射血分数(EF)的变化。结果 89例均达消融终点,术后3个月保持窦性心律且无房性心律失常发作的患者64例,其中阳性组23例,阴性组41例。阳性组成功率高于阴性组(85.19%vs66.13%,P<0.05)。术后6个月阳性组HRV较术前降低(P<0.05),阴性组无明显变化(P>0.05)。与术前比较两组术后6个月的LAD减小、EF增加(P<0.05),阳性组LAD减小值高于阴性组(P<0.05),而EF增加值无差异(P>0.05)。结论环肺静脉消融术治疗房颤过程中发生去迷走效应及碎裂电位消融可伴有房颤消融成功率的增加,左房内径减小,不降低患者的EF值。     

慢性心房颤动导管消融:碎裂电位消融和线性消融的比较

目的评价环肺静脉隔离(CPVI)基础上采用心房碎裂电位(CFAEs)消融或(和)线性(Linear)消融进行心房基质改良的疗效。方法回顾性分析156例慢性心房颤动(简称房颤)消融病例,房颤病程2.5±2.3年,左房内径42.4±4.5 mm。根据消融术式改进分为三组CPVI+CFAEs、CPVI+linear和CPVI+CFAEs+Linear组。比较消融术中房颤终止比例及随访疗效。结果三组消融总时间有显著性差异(160±14 min vs 178±9 min vs 241±8min,P<0.01)。CPVI+CFAEs组终止房颤/转变房性心动过速(简称房速)的比例(52.7%)显著高于CPVI+Line-ar组(18.4%),但低于CPVI+CFAEs+Linear组(73.1%)。术后3.1±1.2个月,三组二次消融比例47.3%、51%、38.5%,P=0.43。术后平均随访9.5±1.8个月,三组无房性快速性心律失常复发例数分别为39例(70.9%)、33例(67.3%)和41例(78.8%),P=0.41(服用抗心律失常药物比例25.6%、24.2%和22%,P=0.96)。结论 CP-VI基础上CFAEs消融的房颤终止比例高于单纯线性消融,但低于联合应用CFAEs消融和Linear消融。尽管如此,三组术后二次消融比例和随访成功率无显著性差异。     

触发与基质消融减少房颤：一项国际多中心随机试验

该多中心随机试验比较了3种房颤消融策略：单纯复杂碎裂消融（CFE组）、单纯肺静脉隔离（PVI组）和同时使用两种方法（PVI＋CFE组）。100例药物抵抗频发阵发性房颤和持续性房颤患者,随机分到3组。CFE组用已证实的自动CFE软件标测自发或诱发房颤。所有碎裂QRS〈120ms均被消融直至房颤终止或不能诱发。PVI组患者所有肺静脉均隔离。PVI＋CFE组所有肺静脉均隔离,     

普罗帕酮转复山羊持续性心房颤动过程中左上肺静脉和左房外膜电图的变化

目的研究普罗帕酮转复心房颤动(简称房颤)时左上肺静脉(LSPV)和左房(LA)外膜电图的变化,分析普罗帕酮转复房颤的可能机制。方法在6只山羊的LA前壁及LSPV根部外膜缝合电极片,LA快速刺激诱发房颤,在房颤自发维持超过24h后,静脉滴注普罗帕酮直至房颤终止。分析用药前、后房颤波周长(AFCL)分别延长40,80ms和房颤转复前各16s的间期内,LSPV和LA外膜电图的变化规律。结果6只山羊在经过静脉滴注普罗帕酮后,全部转复为窦性心律。用药前的LSPV的AFCL显著短于LA(P<0.05);用药后LSPV和LA的AFCL都出现逐渐延长,在房颤转复前两者趋于一致。用药前LSPV双电位和碎裂电位的百分比显著高于LA,单电位比例显著低于LA(P<0.05);用药后,LA和LSPV单电位百分比逐渐增加,双电位和碎裂电位逐渐减少,但在LA双电位和碎裂电位的比例始终小于LSPV(P<0.05);在房颤终止前LA先于LSPV出现双电位和碎裂电位的显著减少或消失,当LSPV的双电位和碎裂电位消失后房颤才终止。结论在本模型中,普罗帕酮对左房、肺静脉电生理的影响在房颤的转复过程中起着重要的作用。     

山羊心房颤动进展过程中心房电图形态的演变

目的利用山羊模型研究心房颤动(简称房颤)在由阵发性向持续性转变过程中,心房/肺静脉外膜电图形态的演变。方法在山羊的左房(LA)游离壁外膜和左上肺静脉(LSPV)根部缝合电极片,利用自制的房颤刺激器于体外发放50Hz的刺激,刺激左房,刺激时程1s,每次间隔2s,诱发出自发维持时间超过24h的持续性房颤。将心房/肺静脉外膜电图形态分为单电位(SP)、双电位(DP)和碎裂电位(FP)。分析在基础状态下和房颤维持不同时间时各电位在所有激动中所占比例和动态变化。结果在窦性心律时LA和LSPV全为SP,随着房颤持续时间的延长,两部位的SP比例逐渐减少,DP和FP的比例逐渐增加。房颤刚开始和持续24h后SP的比例在LA分别为94.2%±5.0%和68.4%±6.0%(P<0.01),在LSPV则分别为74.2%±3.3%和40.1%±7.3%(P<0.01)。在房颤自发持续24h后,LA各种形态的电位交替出现,而LSPV可见连续的反复快速激动。结论心房和肺静脉外膜电图的碎裂程度增加,以及肺静脉出现连续的反复快速激动与房颤的持续有关。     

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。     

肺静脉前庭隔离联合碎裂电位指导线性消融治疗持续性心房颤动

目的评价环肺静脉隔离(CPVI)基础上采用心房碎裂电位(CFAEs)指导的线性消融进行心房基质改良的疗效。方法分析66例持续性心房颤动(简称房颤)消融病例,所有患者标测碎裂电位,行环肺静脉隔离后根据标测结果设计消融径线。明确消融术中房颤终止比例及随访疗效。结果所有入选患者CFAEs分布比例从高向低依次为:肺静脉前庭、左房间隔、顶部、前壁等,消融径线主要为顶部线、前壁线、间隔线、峡部线等。入选患者平均消融线(1.9±0.4)根。随访(16.5±3.9)个月,52例(78.8%)患者经过一次消融术未再发心律失常。14例复发,1例为典型心房扑动,10例为阵发性房颤,1例为持续房颤,2例房性心动过速。结论持续性房颤接受CPVI附加CFAEs标测后线性消融有效、安全。     

心房颤动体表心电图主频特点分析

目的通过体表心电图频谱分析,探讨主频与心房颤动的关系。方法随机选取60例心房颤动患者,包括32例阵发性心房颤动(paroxysmal atrial fibrillation,PAF)及28例持续性心房颤动(persistent atrial fibrillation,PeAF),获取体表心电图(surface electrocardiograms,s ECG)胸导联心电信号,以V_4、V_5、V_6代表左心房,V_1、V_2代表右心房,经快速傅立叶变换获取主频值(dominant frequency,DF),分析和比较不同心房频谱在不同类型心房颤动中的特点。结果DF与左心房内径(left atrium diameter,LAD)呈正相关(r=0.67,P0.01),且LAD测值PeAF组高于PAF(P0.05)。各组内V_1与V_2及V_4、V_5、V_6导联DF差异均无统计学意义(P0.05)。PAF组V_(4-6)平均DF值(PAFDF(V4-6))明显大于PAF组V_(1-2)平均DF值(PAFDF_(V1-2))(P0.01),PeAF组V_(1-2)平均DF值(PeAFDF_(v1-2))与PeAF组V_(4-6)平均DF值(PeAFDF_(v4-6))比较差异无统计学意义(P0.05),PeAFDF_(v4-6)明显大于PAFDF_(v4-6)(P0.05),PeAFDF_(v1-2)明显大于PAFDF_(v1-2)(P0.05)。结论相对于心内电生理检查,体表心电图主频分析心房颤动电活动具有相对简易及无创性优势,对于多数阵发性房颤,间接提示左心房驱动起主导作用,对于持续性房颤,其维持基质分布可能更为广泛。     

心房颤动致心动过速性心肌病及导管射频消融术后左心室射血分数恢复的影响因素分析

目的探讨心房颤动(房颤)致心动过速性心肌病(TCM)患者及导管射频消融(RFCA)术后左心室射血分数(LVEF)恢复的影响因素。方法将296例房颤患者分为两组,TCM组32例(LVEF<50%,1组),非TCM组(LVEF≥50%)264例(2组),1组RFCA术后分为LVEF恢复组23例(LVEF≥50%,3组)与未恢复组9例(LVEF<50%,4组),经体表心电图及Holter记录心动过速的平均病程(MCD)、平均持续时间(MPT)及平均心室率(MHR)及术后MPT、MHR,经心脏彩色多普勒超声获取左心室舒张末期内径(LVEDD)及左心房内径(LAD)。随访(7±1.9)个月,研究房颤致TCM及RFCA术后LVEF恢复的影响因素。结果 (1)1组较2组持续性房颤(PeAF)患者多见(χ2=14.6,P<0.01),术前1组心动过速时MPT(t=3.182,P<0.05)及MCD高于2组(t=2.15,P<0.05),MHR显著低于2组(t=-5.384,P<0.05),LAD(t=4.864,P<0.05)及LVEDD(t=2.206,P<0.05)大于2组;(2)环肺静脉电隔离术后,1组较2组需更广范围的碎裂电位消融达到消融终止(χ2=12.04,P<0.01),两组消融终止率(62.5%比69.3%,χ2=0.62,P=0.43)及消融成功率(56.2%比70.1%,χ2=2.53,P=0.11)差异均无统计学意义;(3)与术前比较,1组术后LAD(t=2.09,P<0.05)及LVEDD显著缩小(t=2.44,P<0.05),且LVEF明显增加(t=-8.00,P<0.01)。与3组相比,4组术前MCD较高(t=2.95,P<0.05),术前术后LAD(t=2.64,P<0.05)(t=3.06,P<0.05)及LVEDD(t=2.57,P<0.05)(t=3.28,P<0.05)均较高(P<0.05)、LVEF(t=-3.70,P<0.01)(t=-5.00,P<0.01)较低,3组患者LVEF增幅较4组高(t=2.5,P=0.001);(4)多因素Logistic回归分析发现,PeAF(OR=4.37,P=0.01)、术前MHR(OR=0.936,P<0.0001)及MCD(OR=1.173,P=0.016)是预测房颤发生TCM的独立危险因素。4组术前MCD较3组长(t=2.95,P=0.007),但多元回归未发现术后LVEF恢复的预测因子。结论 PeAF、术前MHR及MCD为房颤致TCM的独立危险因素,RFCA可显著改善多数患者心脏结构和心功能,经较广泛基质消融后,消融成功率及远期预后与非TCM患者相近;未发现RFCA术后LVEF恢复的预测因子。     

犬快速心房起搏心房颤动模型肺静脉及左右心房组织细胞内钙含量变化的实验研究

目的探讨持续性心房颤动(房颤)时肺静脉及心房细胞内钙含量的变化,以期阐明房颤的发病机制。方法建立快速心房起搏式房颤模型犬8只。正常对照犬8只。实验分为6组1.房颤犬左上肺静脉组;2.房颤犬左心房峡部组;3.房颤犬右心耳组;4.正常对照犬左上肺静脉组;5.正常对照犬左心房峡部组;6.正常对照犬右心耳组。每组取相应部位心肌8块。测定细胞内钙含量。结果房颤犬肺静脉、左心房峡部和右心耳组织细胞内钙含量显著高于正常对照组(P<0.05)。房颤犬肺静脉细胞内钙含量显著高于左心房峡部(P<0.05),左心房峡部细胞内钙含量显著高于右心耳(P<0.05)。结论细胞内钙超载,可能是肺静脉和心房发生电重构的原因;肺静脉和左心房峡部,可能是房颤电重构的关键部位。     

Electroanatomic characteristics of atrial premature beats triggering atrial fibrillation in patients with persistent versus paroxysmal atrial fibrillation

APBs in Persistent Versus Paroxysmal AF. BACKGROUND: Although the electrical disconnection between the left atrium (LA) and pulmonary veins (PVs) by radiofrequency catheter ablation has been proven to be effective in controlling atrial fibrillation (AF), the recurrence rate is higher in patients with persistent AF (PeAF) than with paroxysmal AF (PAF). We hypothesized that the origin of the atrial premature beats (APBs) that trigger AF and the pattern of their breakthrough into the LA differ between PAF and PeAF. METHODS: We mapped 75 APBs (53 APBs triggering AF, 22 isolated APBs) from the LA and PVs in 26 patients with AF (age: 49.5 +/- 9.6, males: 23, PAF = 17, PeAF = 9), using a noncontact endocardial mapping (NCM) system. The location of the preferential conduction (PC) sites and their conduction velocity (CV) were compared. RESULTS: In patients with PeAF, the earliest activation (EA) site and exit of the PC were more frequently located on the LA side of the LA-PV junction as compared with PAF (P < 0.001). Eighty-one percent of the PCs were located in the area between the left and right superior PVs. The incidence of PCs was similar between the PeAF and PAF patients (P = NS). PCs were more commonly found with APBs inducing AF (63.3%) than with those not inducing AF (35.2%, P = 0.01). The CV of the PC was slower for PeAF than PAF (P < 0.001). The CV in the LA during sinus rhythm was also slower for PeAF than PAF (P < 0.01). CONCLUSION: PeAF was more frequently triggered by APBs from the LA side of the LA-PV junction than PAF and resulted in slower conduction than did PAF. These findings may help explain the higher potential for recurrence after electrical PV isolation in patients with PeAF.     

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。     

Prevalence and characteristics of continuous electrical activity in patients with paroxysmal and persistent atrial fibrillation

Background: Complex fractionated atrial electrograms (CFAEs) may play a role in the genesis of atrial fibrillation (AF). One type of CFAE is continuous electrical activity (CEA). The prevalence and characteristics of CEA in patients with paroxysmal and persistent AF are unclear.
Methods and Results: In 44 patients (age = 59 ± 8 years) with paroxysmal (25) or persistent (19) AF, bipolar electrograms were systematically recorded for ≥5 seconds at 24 left atrial (LA) sites, including 8 antral sites, and 2 sites within the coronary sinus (CS). CEA was defined as continuous depolarization for > 1 second with no isoelectric interval. CEA was recorded at the LA septum (79%), antrum (66%), posterior (68%) and anterior walls (67%), roof (66%), base of the LA appendage (61%), inferior wall (61%), posterior mitral annulus (48%), CS (41%), and in the LA appendage (14%). Antral CEA was equally prevalent in patients with paroxysmal (63%) and persistent AF (70%, P = 0.12). In patients with paroxysmal AF, the prevalence of CEA was similar among antral and nonantral LA sites, except for the LA appendage. However, in patients with persistent AF, CEA was more prevalent at the nonantral (80%) than antral sites (70%, P = 0.03). CEA at nonantral sites except the CS was more prevalent in persistent than in paroxysmal AF (80% vs 57%, P < 0.001). The mean duration of intermittent episodes of CEA was longer in persistent than in paroxysmal AF (P < 0.001).
Conclusions: The higher prevalence and duration of CEA at nonantral sites in persistent than in paroxysmal AF is consistent with a greater contribution of LA reentrant mechanisms in persistent AF. However, the high prevalence of CEA at nonantral sites in paroxysmal atrial fibrillation (PAF) suggests that CEA alone is a nonspecific marker of appropriate target sites for ablation of AF. The characteristics of CEA that most accurately identify drivers of AF remain to be determined.     

Electrophysiologic Characteristics of Complex Fractionated Atrial Electrograms in Patients with Atrial Fibrillation

Introduction: The underlying mechanisms of complex fractionated atrial electrogram (CFAE) during radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) have not yet been clearly elucidated. We explored the relationships between CFAE and left atrial (LA) voltage, or conduction velocity (CV).
Methods and Results: In 50 patients with AF (23 paroxysmal AF [PAF], 41 males, mean age 55.76 ± 10.16 years), the CFAE (average index of fractionation of electrograms during AF by interval-analysis algorithm, cycle length [CL]≤ 120 ms) areas, voltage, and CV were measured at eight different quadrants in each patient's LA by analyzing a NavX-guided, color-coded CFAE CL map, a voltage map, and an isochronal map (500 ms pacing) generated by contact bipolar electrograms (70–100 points in the LA). The results were: (1) CFAE areas were predominantly located in the septum, roof, and LA appendage; (2) CFAE area had lower voltage than those in non-CFAE area and was surrounded by the areas of high voltage (P < 0.0001); (3) The CFAE areas had low CVs compared with non-CFAE areas (P < 0.001); and (4) The percentage of CFAE area was lower in patients with persistent atrial fibrillation (PeAF) compared with those with PAF (P < 0.05).
Conclusions: The CFAE area, which is primarily located at the septum, has a low voltage with a lower CV, and is surrounded by high-voltage areas. Underlying electroanatomical complexity is associated with clustering of CFAEs.     

High-density activation mapping of fractionated electrograms in the atria of patients with paroxysmal atrial fibrillation

BACKGROUND: Areas of complex fractionated atrial electrograms (CFAEs) have been implicated in the atrial substrate of atrial fibrillation (AF). The mechanisms underlying CFAE in humans are not well investigated. OBJECTIVES: The purpose of this study was to investigate the regional activation pattern associated with CFAE using a high-density contact mapping catheter. METHODS: Twenty patients with paroxysmal AF were mapped using a high-density multielectrode catheter. CFAE were mapped at 10 different sites (left atrium [LA]: inferior, posterior, roof, septum, anterior, lateral; right atrium [RA]: anterior, lateral, posterior, septum). Local atrial fibrillation cycle length (AFCL) was measured immediately before and after the occurrence of CFAE, and the longest electrogram duration (CFAEmax) was assessed. RESULTS: Longer electrogram durations were recorded in the LA compared with the RA (CFAEmax 118 +/- 21 ms vs 104 +/- 23 ms, P = .001). AFCL significantly shortened before the occurrence of CFAEmax compared with baseline (LA: 174 +/- 32 ms vs 186 +/- 32 ms, P = .0001; RA: 177 +/- 31 ms vs 188 +/- 31 ms, P = .0001) and returned to baseline afterwards. AFCL shortened by >or=10 ms in 91% of mapped sites. Two different local activation patterns were associated with occurrence of CFAEmax: a nearly simultaneous activation in all spines in 84% indicating passive activation, and a nonsimultaneous activation sequence suggesting local complex activation or reentry. CONCLUSION: Fractionated atrial electrograms during AF demonstrate dynamic changes that are dependent on regional AFCL. Shortening of AFCL precedes the development of CFAE; thus, cycle length is a major determinant of fractionation during AF. High-density mapping in AF may help to differentiate passive activation of CFAE from CFAE associated with an active component of the AF process.     

The Relationship Between Endocardial Voltage and Regional Volume in Electroanatomical Remodeled Left Atria in Patients with Atrial Fibrillation: Comparison of Three‐Dimensional Computed Tomographic Images and Voltage Mapping

Background: Long‐standing atrial fibrillation (AF) changes left atrial (LA) morphology, and the LA size is related to recurrence after radiofrequency catheter ablation (RFCA). We hypothesize that LA morphology, based on embryological origin, affects the outcome of RFCA. Methods: We analyzed 3D computed tomographic (CT) images of LA in 70 patients with AF (54 males, 55.6 ± 10.5 years old, paroxysmal AF (PAF):persistent AF (PeAF) = 32:38) who underwent RFCA. Each LA image was divided into venous atrium (VA), anterior LA (ALA), LA appendage (LAA), and both antrum. Absolute and relative volumes were calculated, and the lengths of linear ablation sites were measured. Results: (1) In patients with the mean LA voltage ≤ 2.0 mV, LA volume, especially ALA, was larger (P < 0.01) compared to those with LA voltage > 2.0 mV. (2) The total LA volume was significantly larger (P < 0.01) and LAA voltages (P < 0.05) and conduction velocities (P < 0.05) were lower in patients with PeAF than in those with PAF. (3) In patients with recurrence, LA volume was generally larger (P < 0.01) than in those without recurrence. In PAF patients with recurrence, the relative volume of ALA was significantly larger (P < 0.01) than those without recurrence. Conclusions Morphologically remodeled LA has low endocardial voltage, and enlargement of ALA is more significant in electroanatomically remodeled LA. The disproportional enlargement of ALA was observed more often in PAF patients with recurrence after ablation than those without recurrence.     

Automated detection and characterization of complex fractionated atrial electrograms in human left atrium during atrial fibrillation

BACKGROUND: Complex fractionated atrial electrograms (CFAEs) have been reported as ablative targets for the treatment of atrial fibrillation (AF). However, the process of CFAE identification is highly dependent on the operator's judgment. OBJECTIVE: It is the aim of the study to report our initial experience with a novel software algorithm designed to automatically detect CFAEs. METHODS: Nineteen patients (6 female, 58 +/- 8 years) who underwent catheter ablation of paroxysmal (n = 11) or persistent (n = 8) AF were included in the study. During ongoing AF, 100 +/- 15 left atrial (LA) endocardial locations were sampled under the guidance of integrated electroanatomical mapping with computed tomographic images. Bipolar electrograms recorded throughout the LA were analyzed using custom software that allows for automated detection of CFAEs. Interval confidence level (ICL), defined as the number of intervals between consecutive CFAE complexes during 2.5-second recordings, was used to characterize CFAEs. The CFAE sites with an ICL >/=5 were considered as sites with highly repetitive CFAEs, which are thought to be potential ablation targets. For purposes of analysis, the LA was divided into 6 areas: pulmonary vein (PV) ostia, posterior wall, interatrial septum, roof, mitral annulus area, and appendage. RESULTS: Among a total of 1,904 LA locations sampled in 19 patients, 1,644 (86%) were categorized as CFAE sites, whereas 260 (14%) were categorized as as non-CFAE sites. Thirty-four percent of all CFAE sites were identified as sites with highly repetitive CFAEs. Of these, 24% were located at the interatrial septum, 22% on the posterior wall, 20% at the PV ostia, 18% at the mitral annulus area, 14% on the roof, and 2.7% at the LA appendage. In all patients, highly repetitive CFAE sites were distributed in 4 or more areas of the LA. Persistent AF patients had more highly repetitive CFAE sites on the posterior wall than paroxysmal AF patients (30% +/- 7.3% vs 14% +/- 8.2%, P < .001). There was a strong trend toward more highly repetitive CFAE sites located at the PV ostia in patients with paroxysmal AF compared with persistent AF patients (24% +/- 13% vs 13% +/- 7.7%, P = .05). CONCLUSION: With the use of custom software, CFAE complexes were identified in more than 80% of the LA endocardial locations. LA sites with highly repetitive CFAE sites were located predominately in the septum, posterior wall, and PV ostia. Patients with persistent AF had a different anatomical distribution pattern of highly repetitive CFAE sites from those with paroxysmal AF, with a greater prevalence of highly repetitive CFAEs located on the posterior wall. Further studies are warranted to determine the clinical significance of these findings.     

单纯碎裂电位指导心房颤动消融的初步临床观察

目的探讨碎裂电位指导心房颤动（房颤）射频导管消融的可行性。方法22例药物治疗无效有症状的房颤患者（阵发性16例,持续性6例）,在自发或诱发房颤时,用Carto构建左心房或左、右心房的三维模型并标测、消融碎裂电位,终点是消除标测到所有碎裂电位或转复窦性心律。结果碎裂电位消融后,13例（59％）转复为窦性心律（直接转复7例,先转为房性心动过速（房速）／心房扑动（房扑）然后转复6例）,9例消融未转复窦性心律患者行电复律或药物复律成功。6例复发（5例房速／房扑,1例阵发性房颤）再次消融,5例成功,随访3—18（10．9±4．8）个月,共有16例（73％）无快速房性心律失常事件,碎裂电位主要分布于左侧房间隔、肺静脉周围、左心房顶部。碎裂电位消融后房颤终止前房颤周期与碎裂电位消融前相比明显延长[（157±18）ms vs （211±32）ms,P〈0．05]。除一例发生心脏压塞且心包穿刺成功引流外,无消融术相关的并发症和后遗症。结论碎裂电位指导房颤导管射频消融安全有效可行。     

Complex fractionated electrograms in the right atrial free wall and the superior/posterior wall of the left atrium are affected by activity of the autonomic nervous system

CFAEs and Autonomic Nervous System . Background: Complex fractionated atrial electrograms (CFAEs) are supposed to be related to structural and electrical remodeling. Animal studies suggest a role of the autonomic nervous system (ANS). However, this has never been studied in humans. Objective: The goal of this study was to investigate the influence of ANS on CFAEs in patients with idiopathic atrial fibrillation (AF). Methods: Thirty‐six patients (28 men, 55 ± 9 years) were included before undergoing catheter ablation. In the 24 hours preceding the procedure, 20 patients were in AF (group 1) and 16 were in sinus rhythm (SR, group 2). With 2 decapolar catheters, 1 in the right atrium (RA) and 1 in the left atrium (LA), 20 unipolar electrograms were simultaneously recorded during a 100‐second AF‐period (in group 2 after induction of AF). After atropine and metoprolol administration, a second 100‐second AF‐period was recorded 30 minutes later. Five patients of group 2 served as controls and did not receive atropine and metoprolol prior to the second recording. CFAEs were assessed and the prevalence of CFAEs was expressed as percentage of the recording time. Results: The prevalence of CFAEs was greater in group 1 than in group 2 in both RA and LA (P = 0.026, P < 0.001, respectively). Atropine and metoprolol significantly reduced CFAEs in group 1 (P < 0.001) and prevented the time‐dependent increase of CFAEs in group 2. Conclusion: The prevalence of CFAEs is greater in long‐lasting AF episodes. Atropine and metoprolol administration reduces CFAEs in both atria. Thus, CFAEs are at least partly influenced by the ANS. (J Cardiovasc Electrophysiol, Vol. 23, pp. 26‐33, January 2012)     

心房可兴奋间期对山羊心房颤动稳定性的影响

目的研究山羊心房可兴奋间期(EP)在心房颤动(房颤)稳定过程中的作用。方法在10只山羊的左心房游离壁外膜缝合电极片,利用自制的房颤刺激器于体外发放50HZ的刺激1S,每次间隔2S,诱发维持时间超过24H的持续性房颤。定期终止刺激,记录房颤自发持续时间,计算平均房颤波周长(AFCL),并在房颤持续过程中利用感知房颤波发放刺激夺获心房的方法测量房颤时心房有效不应期(ERPAF),计算EP(EP=AFCL-ERPAF)。结果8只山羊完成实验,均在6~16(9·3±4·6)D内诱发出持续超过24H的持续性房颤。在房颤自发维持达3~10MIN和24H时的AFCL分别为98·3MS±11·0MS与84·9MS±5·2MS,P<0·05;ERPAF分别为90·5MS±13·2MS与63·0MS±4·8MS,P<0·05;EP分别为7·8MS±2·4MS与21·9MS±3·5MS,P<0·05。结论心房ERPAF的缩短大于AFCL的缩短,使得EP持续性增宽,可能在房颤的稳定过程中起重要作用。