Accumulating data have shown that elimination of atrial fibrillation(AF) sources should be the goal in persistent AF ablation. Pulmonary vein isolation, linear lesions and complex fractionated atrial electrograms(CFAE...Accumulating data have shown that elimination of atrial fibrillation(AF) sources should be the goal in persistent AF ablation. Pulmonary vein isolation, linear lesions and complex fractionated atrial electrograms(CFAEs) ablation have shown limited efficacy in patients with persistent AF. A combined approach using voltage, CFAEs and dominant frequency(DF) mapping may be helpful for the identification of AF sources and subsequent focal substrate modification. The fibrillatory activity is maintained by intramural reentry centered on fibrotic patches. Voltage mapping may assist in the identification of fibrotic areas. Stable rotors display the higher DF and possibly drive AF. Furthermore, the single rotor is usually consistent with organized AF electrograms without fractionation. It is therefore quite possible that rotors are located at relatively "healthy islands" within the patchy fibrosis. This is supported by the fact that high DF sites have been negatively correlated to the amount of fibrosis. CFAEs are located in areas adjacent to high DF. In conclusion, patchy fibrotic areas displaying the maximum DF along with high organization index and the lower fractionation index are potential targets of ablation. Prospective studies are required to validate the efficacy of substrate modification in left atrial ablation outcomes.展开更多
Multiple wavelet hypothesis and fibrillatory conduction are believed to be atrial fibrillation's pathogenesis. Radio frequency ablation(RFA) technique, a therapy for atrial fibrillation(AF), applies radio frequenc...Multiple wavelet hypothesis and fibrillatory conduction are believed to be atrial fibrillation's pathogenesis. Radio frequency ablation(RFA) technique, a therapy for atrial fibrillation(AF), applies radio frequency(RF) energy to targeted tissue to make it transmural. Research on AF ablation has already been conducted in China. Currently, there are single-electrode and dual-electrode ablation electrodes. It is discovered that the latter can reduce the treatment time and maintain the ablation shape of the tissue. Clinical application has shown that it has become the first-line treatment option for part of indications patients with AF.展开更多
文摘Accumulating data have shown that elimination of atrial fibrillation(AF) sources should be the goal in persistent AF ablation. Pulmonary vein isolation, linear lesions and complex fractionated atrial electrograms(CFAEs) ablation have shown limited efficacy in patients with persistent AF. A combined approach using voltage, CFAEs and dominant frequency(DF) mapping may be helpful for the identification of AF sources and subsequent focal substrate modification. The fibrillatory activity is maintained by intramural reentry centered on fibrotic patches. Voltage mapping may assist in the identification of fibrotic areas. Stable rotors display the higher DF and possibly drive AF. Furthermore, the single rotor is usually consistent with organized AF electrograms without fractionation. It is therefore quite possible that rotors are located at relatively "healthy islands" within the patchy fibrosis. This is supported by the fact that high DF sites have been negatively correlated to the amount of fibrosis. CFAEs are located in areas adjacent to high DF. In conclusion, patchy fibrotic areas displaying the maximum DF along with high organization index and the lower fractionation index are potential targets of ablation. Prospective studies are required to validate the efficacy of substrate modification in left atrial ablation outcomes.
基金the Shanghai Science and Technology Research Projects Fund(No.11441900200)the National Key Technology R&D Program(No.2012BAI15B07)
文摘Multiple wavelet hypothesis and fibrillatory conduction are believed to be atrial fibrillation's pathogenesis. Radio frequency ablation(RFA) technique, a therapy for atrial fibrillation(AF), applies radio frequency(RF) energy to targeted tissue to make it transmural. Research on AF ablation has already been conducted in China. Currently, there are single-electrode and dual-electrode ablation electrodes. It is discovered that the latter can reduce the treatment time and maintain the ablation shape of the tissue. Clinical application has shown that it has become the first-line treatment option for part of indications patients with AF.
文摘目的探讨消融旁道后心房颤动(房颤)复发的预激综合征患者24 h动态心电图最大P波时限(Pmax)、P波离散度(Pd),并分析其对房颤复发的预测效能及临床意义。方法选取2019年5月~2022年5月北京中医医院顺义医院52例消融旁道后房颤复发的预激综合征患者为研究组,另选同期52例消融旁道后无房颤复发的预激综合征患者为对照组。比较两组临床资料、消融前后24 h动态心电图P波参数(Pmax、Pd)及变化值(△Pmax、△Pd)。Lasso-logistic回归模型分析房颤复发的相关因素。分析消融前、消融后2 d P波参数及变化值对房颤复发的预测价值。结果研究组年龄、病程、左心房内径、消融前房颤发作频率、消融前Pmax、Pd及消融后2 d Pmax、Pd均高于对照组[(50.26±8.13)岁比(41.31±7.65)岁、(5.29±1.18)年比(4.06±0.95)年、(42.39±4.12)mm比(32.68±3.97)mm、(5.79±1.26)次/月比(3.82±1.04)次/月、(121.57±11.68)ms比(104.95±10.24)ms、(55.36±8.73)ms比(41.70±7.21)ms、(112.39±10.75)ms比(92.44±9.30)ms、(50.18±7.69)ms比(34.07±6.42)ms],研究组LVEF、△Pmax、△Pd均低于对照组[(56.27±10.35)%比(65.14±11.42)%、(9.18±1.69)ms比(12.51±1.81)ms、(5.18±1.22)ms比(7.63±1.43)ms,P<0.05]。年龄、LVEF、消融前房颤发作频率、消融前后Pmax、Pd、△Pmax、△Pd为房颤复发的影响因素(P<0.05);△Pmax、△Pd联合预测房颤复发的AUC为0.931,大于消融前后Pmax、Pd联合预测的AUC 0.853、0.876(P<0.05);基于影响因素构建预测模型,含P波参数变化值预测房颤复发的AUC为0.952,大于不含P波参数变化值预测的AUC 0.875(P<0.05)。结论24 h动态心电图Pmax、Pd变化值对预激综合征患者消融旁道后房颤复发具有一定预测价值。
