Interv Akut Kardiol. 2013;12(1):12-18

Vztah mezi automaticky detekovanými komplexními frakcionovanými elektrogramy a místy ukončené dlouhodobé perzistentní fibrilace síní při katetrové ablaci

Martin Fiala1,2, Dan Wichterle3,4, Veronika Bulková1,4, Libor Škňouřil1, Renáta Nevřalová1, Jan Chovančík1, Jaroslav Januška1, Jindřich Špinar2
1 Department of Cardiology, Heart Centre, Hospital Podlesí a. s., Třinec
2 Department of Cardiology and Angiology, University Hospital, Masaryk University, Brno
3 Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague
4 Department of Cardiology and Angiology, First Faculty of Medicine, Charles University, Prague

Úvod: Komplexní frakcionované síňové potenciály (CFAE) mohou poskytnout vodítko při ablaci perzistentní fibrilace síní (FS). Tato studie hodnotila

vztah mezi automaticky detekovanými CFAE v srdečních síních a místy, v nichž došlo k ukončení dlouhodobé perzistentní FS ablací.

Metodika: Padesát konsekutivních pacientů podstoupilo stupňovanou ablaci dlouhodobé perzistentní FS. Před ablací byly vytvořeny

elektroanatomické mapy levé síně (LS), pravé síně (PS) a koronárního sinu (CS) s automaticky detekovanými CFAE. Stupňovaná ablace

se snahou obnovit sinusový rytmus jako ideálním cílovým momentem výkonu se provedla s použitím jednobarevné elektroanatomické

mapy. Vztah mezi místy CFAE a místy ukončení FS byl retrospektivně analyzován u 38 pacientů, u nichž byla FS terminována ablací.

Výsledky: Bylo nalezeno 70 míst CFAE v LS, 48 míst CFAE v PS a 20 míst CFAE v CS u 35 (92 %), 30 (79 %), respektive 19 (50 %) pacientů.

Průměrná vzdálenost mezi místem ukončení FS a nejbližším místem CFAE byla 21,7±17 mm. Průměrná vzdálenost mezi místem ukončení

FS a nejbližším místem CFAE ≤10, respektive 11–20 mm byla nalezena u 11 (29 %), respektive 10 (26 %) pacientů. Ukončení FS bylo dosaženo

až po ablaci 85±28 % míst CFAE v LS, 58±28 % míst CFAE v CS, a 16±33 % míst CFAE v PS.

Závěr: Ačkoli u většiny pacientů místa CFAE přímo nekorelovala s místy ukončení FS, většina míst CFAE v LS a více než polovina míst

CFAE v CS byla cílena před dosažením terminace FS, což naznačuje spíše kumulativní efekt ablace CFAE.

Keywords: fibrilace síní, dlouhodobá perzistentní, katetrová ablace, komplexní frakcionované síňové potenciály

Published: February 21, 2013  Show citation

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Fiala M, Wichterle D, Bulková V, Škňouřil L, Nevřalová R, Chovančík J, et al.. Vztah mezi automaticky detekovanými komplexními frakcionovanými elektrogramy a místy ukončené dlouhodobé perzistentní fibrilace síní při katetrové ablaci. Interv Akut Kardiol. 2013;12(1):12-18.
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    References

    1. Ha?ssaguerre M, Sanders P, Hocini M, et al. Catheter ablation of long-lasting persistent atrial fibrillation: critical structures for termination. J Cardiovasc Electrophysiol 2005; 16: 1125-1137. Go to original source... Go to PubMed...
    2. Ha?ssaguerre M, Hocini M, Sanders P, et al. Localized sources maintaining atrial fibrillation organized by prior ablation. Circulation 2006; 113: 616-625. Go to original source... Go to PubMed...
    3. Rostock T, Steven D, Hoffmann BA, et al. Chronic atrial fibrillation is a biatrial arrhythmia: data from catheter ablation of chronic atrial fibrillation aiming arrhythmia termination using a sequential ablation approach. Circ Arrhythm Electrophysiol 2008; 1: 344-353. Go to original source... Go to PubMed...
    4. Fiala M, Chovančík J, Nevřalová R, et al. Termination of long-lasting persistent versus short-lasting persistent and paroxysmal atrial fibrillation by ablation. Pacing Clin Electrophysiol 2008; 31: 985-997. Go to original source... Go to PubMed...
    5. Hocini M, Nault I, Wright M, et al. Disparate evolution of right and left atrial rate during ablation of long-lasting persistent atrial fibrillation. J Am Coll Cardiol 2010; 55: 1007-1016. Go to original source... Go to PubMed...
    6. Scherr D, Dalal D, Cheema A, et al. Automated detection and characterization of complex fractionated atrial electrograms in human ledt atrium during atrial fibrillation. Heart Rhythm 2007; 4: 1013-1020. Go to original source... Go to PubMed...
    7. Porter M, Spear W, Akar JG, et al. Prospective study of atrial fibrillation termination during ablation guided by automated detection of fractionated electrograms. J Cardiovsc Electrophysiol 2008; 19: 613-620. Go to original source... Go to PubMed...
    8. Cal? L, De Ruvo E, Sciarra L, et al. Diagnostic Accuracy of a new software for complex fractionated electrograms identification in patients with persistent and permanent atrial fibrillation. J Cardiovasc Electrophysiol 2008; 19: 1024-1030. Go to original source... Go to PubMed...
    9. Fiala M, Chovančík J, Wojnarová D, et al. Results of complex left atrial ablation of long-lasting persistent atrial fibrillation. J Interv Card Electrophysiol 2008; 23: 189-198. Go to original source... Go to PubMed...
    10. Natale A, Leonelli F, Beheiry S, et al. Catheter ablation approach on the right side only for paroxysmal atrial fibrillation therapy: long-tem results. Pacing Clin Electrophysiol 2000; 23: 224-233. Go to original source... Go to PubMed...
    11. O'Neill MD, Wright M, Knecht S, et al. Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint. Eur Heart J 2009; 30: 1105-1112. Go to original source... Go to PubMed...
    12. Nademanee K, McKenzie J, Kosar E, et al. A new approach or catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol 2004; 43: 2044-2053. Go to original source... Go to PubMed...
    13. Kalifa J, Tanaka K, Zaitsev AV, et al. Mechanism of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of the isolated sheep heart during atrial fibrillation. Circulation 2006; 113: 626-633. Go to original source... Go to PubMed...
    14. Tanaka K, Zlochiver S, Vikstrom KL, et al. Spatial distribution of fibrosis governs fibrillation wave dynamics in the posterior left atrium during heart failure. Circ Res 2007; 101: 839-847. Go to original source... Go to PubMed...
    15. Armour JA, Murphy DA, Yuan BX, Macdonald S, Hopkins DA. Gross and microscopic anatomy of the human intrinsic cardiac nervous system. Anat Rec 1997; 247: 289-298. Go to original source... Go to PubMed...
    16. Lin J, Scherlag BJ, Zhou J, et al. Autonomic mechanism to explain complex fractionated atrial electrograms (CFAE). J Cardiovasc Elecrophysiol 2007; 18: 1197-1205. Go to original source... Go to PubMed...
    17. Lemery R, Birnie D, Tang AS, Green M, Gollob M. Feasibility study of endocardial mapping of ganglionated plexuses during catheter ablation of atrial fibrillation. Heart Rhythm 2006; 3: 387-396. Go to original source... Go to PubMed...
    18. Spach MS, Dolber PC, Heidlage JF. Influence of passive anisotropic properties on directional differences in propagation following modification of the sodium conductance in human atrial muscle. Circ Res 1988; 62: 811-832. Go to original source... Go to PubMed...
    19. Spach MS, Heidlage JF, Dolber PC, Barr RC. Mechanism of origin of conduction disturbances in aging human atrial bundles. Experimental and model study. Heart Rhythm 2007; 4: 175-185. Go to original source... Go to PubMed...
    20. Konings KT, Kirchhof CJ, Smeets JR, Wellens HJ, Penn OC, Allessie MA. High-density mapping of electrically induced atrial fibrillation in humans. Circulation 1994; 89: 1665-1680. Go to original source... Go to PubMed...
    21. Konings KT, Smeets JR, Penn OC, et al. Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. Circulation 1997; 95: 1231-1241. Go to original source... Go to PubMed...
    22. Oral H, Chugh A, Good E, et al. Radiofrequency catheter ablation of chronic atrial fibrillation guided by complex electrograms. Circulation 2007; 115: 2606-2612. Go to original source... Go to PubMed...
    23. Oral H, Chugh A, Good E, et al. Randomized evaluation of right atrial ablation after left atrial ablation of complex fractionated atrial electrograms for long-lasting persistent atrial fibrillation. Circ Arrhythm Electrophysiol 2008; 1: 6-13. Go to original source... Go to PubMed...
    24. Ha?ssaguerre M, Hocini M, Sanders P, et al. Catheter ablation of long-lasting atrial fibrillation: clinical outcome and mechanisms of subsequent arrhythmias. J Cardiovasc Electrophysiol 2005; 16: 1138-1147. Go to original source... Go to PubMed...
    25. Knecht S, Hocini M, Wright M, et al. Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation. Eur Heart J 2008; 29: 2359-2366. Go to original source... Go to PubMed...
    26. Wu J, Estner H, Luik A, et al. Automatic 3D mapping of complex fractionated electrograms (CFAE) in patients with paroxysmal and persistent atrial fibrillation. J Cardiovasc Electrophysiol 2008; 19: 897-903. Go to original source... Go to PubMed...
    27. Bencsik G, Martinek M, Hassanein S, Aichinger J, Nesser HJ, Purerfellner H. Acute effects of complex fractionated atrial electrogram ablation on dominant frequency and regulatory index for the fibrillatory process. Europace 2009; 11: 1011-1017. Go to original source... Go to PubMed...

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