Prevalence, characteristics, mapping, and catheter ablation of potential rotors in nonparoxysmal atrial fibrillation

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题名:	Prevalence, characteristics, mapping, and catheter ablation of potential rotors in nonparoxysmal atrial fibrillation
作者:	黃鍔;Lin, Yenn-Jiang;Lo, Men-Tzung;Lin, Chen;Chang, Shih-Lin;Lo, Li-Wei;Hu, Yu-Feng;Hsieh, Wan-Hsin;Chang, Hung-Yu;Lin, Wen-Yu;Chung, Fa-Po;Liao, Jo-Nan;Chen, Yun-Yu;Hanafy, Dicky;Huang, Norden E.;Chen, Shih-Ann
贡献者:	認知智慧與精準健康照護研究中心
关键词:	Adult;Aged;Atrial Fibrillation - physiopathology;Atrial Fibrillation - surgery;Catheter Ablation - methods;Electrocardiography;Electrophysiologic Techniques, Cardiac;Female;Heart Conduction System - physiopathology;Heart Conduction System - surgery;Humans;Male;Middle Aged;Prevalence;Pulmonary Veins - physiopathology;Pulmonary Veins - surgery
日期:	2013-10-01
上传时间:	2026-04-23 14:26:48 (UTC+8)
出版者:	Lippincott Williams and Wilkins Ltd.;United States: Ovid Technologies (Wolters Kluwer Health)
摘要:	摘要： Background—Identification of critical atrial substrates in patients with nonparoxysmal atrial fibrillation (AF) failing to respond to pulmonary vein isolation is important. This study investigated the signal characteristics, substrate nature, and ablation results of rotors during AF.Methods and Results—In total, 53 patients (age=55±8), 31 with persistent AF and 22 with long-lasting AF, underwent pulmonary vein isolation and substrate modification of complex fractionated atrial electrograms. Small-radius-reentrant rotors were identified from signal analyses of the dominant frequency and fractionation interval and nonlinear analyses (newly developed, beat-to-beat nonlinear measurement of the repetitiveness of the electrogram morphology >6 seconds). In 15% of the patients, activation maps demonstrated occurrences of rotor-like small-radius reentrant circuits (n=9; 1.1 per patient; cycle length=110±21 ms; diameter=11±6 mm) with fibrillation occurring outside these areas. Rotors were identified by conventional point-by-point mapping and signal analyses and were subsequently eradicated by catheter ablation in these patients. Persistent AF for <1 year, a smaller left atrial size, substrates with higher mean voltages and shorter total activation durations predicted a higher incidence of rotors (allP<0.05). In the multivariable model, areas of reentrant circuits exhibited a higher dominant frequency, kurtosis, and higher degree of a beat-to-beat electrogram similarity than areas without or outside the rotors (allP<0.05).Conclusions—Rotor-like re-entry with fibrillatory conduction was found in a limited number of patients with nonparoxysmal AF after pulmonary vein isolation. Those areas were characterized by rapid repetitive activity with a high degree of electrogram similarity. 其他題名： Circ Arrhythm Electrophysiol 出版者： United States: Ovid Technologies (Wolters Kluwer Health) 出版日期： 2013-10 出處： Circulation. Arrhythmia and electrophysiology, 2013-10, Vol.6 (5), p.851-858 版權： 2013 American Heart Association, Inc. 識別號： ISSN: 1941-3149 識別號： ISSN: 1941-3084 識別號： EISSN: 1941-3084 識別號： DOI: 10.1161/circep.113.000318 識別號： PMID: 23983246
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