摘要
目的探讨心房高密度标测时持续性心房颤动(房颤)驱动区域的心腔内电图特征。方法本研究为前瞻性队列研究。前瞻性纳入2018年9月至2022年1月在北京朝阳医院接受肺静脉前庭隔离联合低剂量(0.004 mg/kg)伊布利特注射后房颤未能终止的持续性房颤患者, 采用20极星状标测导管进行双心房高密度标测, 标记并消融房颤驱动区域。腔内电图离散度>冠状静脉窦导管记录的房颤波周长90%的区域被定义为房颤驱动区域。结果共入选113例患者, 其中男77例, 女36例, 年龄(63.8±11.0)岁。共记录到238个房颤驱动区域, 每例患者有(2.1±1.4)个房颤驱动区域。其中83例(73.5%, 83/113)患者在消融驱动区域过程中房颤终止, 其余30例(26.5%, 30/113)患者最终经直流电复律终止房颤。以长时程(>50 ms)电位、低振幅(<0.3 mV)及短周长(与冠状静脉窦的房颤波周长相比, 局部房颤波周长更短)为特征的房颤关键驱动区域腔内电图的发生率在确定的及可能的驱动区域中(长时程:77.1%、62.9%;低振幅:67.5%、62.9%;短周长:43.4%、58.8%), 明显高于假性驱动区域(长时程:67.2%;低振幅:43.1%;短周长:17.2%;P=0.018)。结论高离散度、长时程、低振幅和短周长是持续性房颤心房关键驱动区域的腔内电图特征。
Objective To investigate the electrogram characteristics of persistent atrial fibrillation(AF)drivers during atrial high density mapping.Methods This is a prospective cohort study.From September 2018 to January 2022,patients with persistent AF who failed to terminate AF after receiving pulmonary venous antral isolation(PVAI)combined with low-dose(0.004 mg/kg)ibutilide at Beijing Chaoyang Hospital were enrolled.Bi-atrial high density mapping using a 20-pole PentaRay catheter and ablation of AF drivers were performed in these patients.Areas with displayed dispersed atrial electrograms(>90%of the mean AF cycle length in the coronary sinus)were defined as AF driver regions.Results A total of 113 patients were enrolled,including 77 males and 36 females,with an average age of(63.8±11.0)years.A total of 238 AF driving regions were recorded,with(2.1±1.4)AF driving regions per patient.Of these,83(73.5%,83/113)patients terminated AF during ablation of the driving area,and the remaining 30(26.5%,30/113)patients were finally terminated AF by direct current cardioversion.The presence of electrograms in key driving areas of AF characterized by long duration(>50 ms)potential,low-voltage(<0.3 mV),and short cycle length(shorter local AF cycle length compared to that of the coronary sinus)were significantly higher in the definite and plausible driving areas(long duration potential:77.1%,62.9%;low-voltage:67.5%,62.9%;short cyde length:43.4%,58.8%)than in the pseudo driving areas(long duration potential:67.2%;low-voltage:43.1%;short cgde length:17.2%;P=0.018).Conclusion In patients with persistent AF refractory to PVAI,high dispersion,long duration,low-voltage,and short AF cycle length are the characteristics of intracavitary electrograms in the key driving areas.
作者
石亮
王彦江
张健
廖文凯
周杨
陶依娆
刘小青
张建军
刘兴鹏
Shi Liang;Wang Yanjiang;Zhang Jian;Liao Wenkai;Zhou Yang;Tao Yirao;Liu Xiaoqing;Zhang Jianjun;Liu Xingpeng(Department of Cardiology,Heart Center,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Cardiology,Dezhou The Seventh People′s Hospital,Dezhou 253000,China)
出处
《中华心律失常学杂志》
2023年第6期505-512,共8页
Chinese Journal of Cardiac Arrhythmias
关键词
心房颤动
高密度标测
射频消融
驱动区域
伊布利特
离散度
Atrial fibrillation
High density mapping
Radiofrequence ablation
Drivers
Ibutilide
Dispersion
