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

Electrophysiologic characteristics of continuous complex fractionated atrial electrograms in pulmonary veins ostia and left atrium during atrial fibrillation

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。

Objective To investigate the electrophysiologic characteristics of continuous complex fractionated atrial electrograms （CFAEs） in pulmonary veins osfia （PVO） and left atrium （LA） during atrial fibrillation （AF）. Methods Twenty-four patients with drug refractory paroxysmal AF （PAF group） （n = 12 ） and persistent AF （PeAF group） （n = 12） were enrolled. The PVO was divided into area I and II, the distance of which was 5 - 10 mm and 10 -20 mm from the PV orifices. High-density mapping the PVO and LA was performed using a three-dimensional electroanatomic mapping sys- tem （EnSite NavX） during spontaneous or induced AF. The eleetrophysiologic characteristics of the continuous CFAEs （ CFE-mean≤70 ms） was compared between two groups. Results （1）The average LA diameter in PeAF group was larger than the PAF group （P 〈 0.05）. In the PAF group, the least and most prevalent continuous CFAEs were in the LA roof and posterior wall respectively, while in the PeAF group, those were in the LA posterior or anterior walls, and appendage, seperately. The prevalence of the continuous CFAEs in the PVO which was apparently more prevalent than the LA （P 〈 0. 05） in the PAF group, and was similar in the PeAF group. （2）In the PeAF group, the continuous CFAEs at the LA was more prevalent in the PVO （P 〈 0.05 ）, but was equally prevalent in the PVO between two group（ P = 0. 58 ）. More continuous CFAEs was recorded at the left inferior PVO in the PAF group （P = 0. 02 ）, while no significant difference of the continuous CFAEs distribution was found in the other PVO between two groups. Except for the LA roof where more continuous CFAEs distribution in the PAF group than the PeAF group were observed （ P = 0.02）, the CFAEs distribution at the LA inferior wall, appendage, and mitral annulus in the PeAF group were more prevalent than the PAF group, and were fairly distributed in the other LA regions. （3）The preva- lece of the continuous CFAEs at area Ⅰ in each PVO in PAF group was more than area Ⅱ （ P 〈 0.05 ）. More continuous CFAEs in left inferior PVO and less continuous CFAEs in right superior PVO at area Ⅰ were recorded in PeAF group, and without significance differencs in other PVOs. （4）In the PAF group, CFE-mean value was significantly lower in the PVO compared with the LA （ P 〈 0.05 ） , which was without significant difference between two regions in the PeAF group and in the PVO between two groups. Lower CFE-mean value, more points of continuous CFAEs （ P = 0. 001 ） and AFCL （ P = 0. 006） were recorded in the PeAF group compared with the PAF group. Conclusions The higher prevalence and duration of the continuous CFAES in the LA and the longer AFCL in PeAF than PAF imply that the anatomically and electroanatomi- cally remodeled LA plays an important role in maintaining AF. Most continuous CFAEs in PVO are concentrated in the 5 - 10 mm area.