Inverse Relationship Between Fractionated Electrograms and Atrial Fibrosis in Persistent Atrial Fibrillation Combined Magnetic Resonance Imaging and High-Density Mapping

被引：168

作者：

Jadidi, Amir S. ^{[1
,2
,3
]}

Cochet, Hubert ^{[1
,2
]}

Shah, Ashok J. ^{[1
,2
]}

Kim, Steven J. ^{[4
]}

Duncan, Edward ^{[1
,2
]}

Miyazaki, Shinsuke ^{[1
,2
]}

Sermesant, Maxime ^{[5
]}

Lehrmann, Heiko ^{[3
]}

Lederlin, Matthieu ^{[1
,2
]}

Linton, Nick ^{[1
,2
]}

Forclaz, Andrei ^{[1
,2
]}

Nault, Isabelle ^{[1
,2
]}

Rivard, Lena ^{[1
,2
]}

Wright, Matthew ^{[1
,2
]}

Liu, Xingpeng ^{[1
,2
]}

Scherr, Daniel ^{[1
,2
]}

Wilton, Stephen B. ^{[1
,2
]}

Roten, Laurent ^{[1
,2
]}

Pascale, Patrizio ^{[1
,2
]}

Derval, Nicolas ^{[1
,2
]}

Sacher, Frederic ^{[1
,2
]}

Knecht, Sebastien ^{[1
,2
]}

Keyl, Cornelius ^{[3
]}

Hocini, Meleze ^{[1
,2
]}

Montaudon, Michel ^{[1
,2
]}

Laurent, Francois ^{[1
,2
]}

Haissaguerre, Michel ^{[1
,2
]}

Jais, Pierre ^{[1
,2
]}

机构：

[1] Hop Cardiol Haut Leveque, F-33604 Bordeaux, France

[2] Univ Bordeaux 2, F-33076 Bordeaux, France

[3] Univ Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany

[4] St Jude Med, St Paul, MN USA

[5] INRIA, Asklepios Project, Sophia Antipolis, France

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2013年 / 62卷 / 09期

关键词：

ablation; atrial delayed enhancement; atrial fibrillation; atrial fibrosis; complex fractionated atrial electrogram; cycle length; MRI; pulmonary vein isolation; ACTIVATION; MECHANISM; ABLATION;

D O I：

10.1016/j.jacc.2013.03.081

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to evaluate the relationship between fibrosis imaged by delayed-enhancement (DE) magnetic resonance imaging (MRI) and atrial electrograms (Egms) in persistent atrial fibrillation (AF). Background Atrial fractionated Egms are strongly related to slow anisotropic conduction. Their relationship to atrial fibrosis has not yet been investigated. Methods Atrial high-resolution MRI of 18 patients with persistent AF (11 long-lasting persistent AF) was registered with mapping geometry (NavX electro-anatomical system (version 8.0, St. Jude Medical, St. Paul, Minnesota)). DE areas were categorized as dense or patchy, depending on their DE content. Left atrial Egms during AF were acquired using a high-density, 20-pole catheter (514 +/- 77 sites/map). Fractionation, organization/regularity, local mean cycle length (CL), and voltage were analyzed with regard to DE. Results Patients with long-lasting persistent versus persistent AF had larger left atrial (LA) surface area (134 +/- 38 cm(2) vs. 98 +/- 9 cm(2), p = 0.02), a higher amount of atrial DE (70 +/- 16 cm(2) vs. 49 +/- 10 cm(2), p = 0.01), more complex fractionated atrial Egm (CFAE) extent (54 +/- 16 cm(2) vs. 28 +/- 15 cm(2), p 0.02), and a shorter baseline AF CL (147 +/- 10 ms vs. 182 +/- 14 ms, p 0.01). Continuous CFAE (CFEmean [NavX algorithm that quantifies Egm fractionation] <80 ms) occupied 38 +/- 19% of total LA surface area. Dense DE was detected at the left posterior left atrium. In contrast, the right posterior left atrium contained predominantly patchy DE. Most CFAE (48 +/- 14%) occurred at non-DE LA sites, followed by 41 +/- 12% CFAE at patchy DE and 11 +/- 6% at dense DE regions (p = 0.005 and p = 0.008, respectively); 19 +/- 6% CFAE sites occurred at border zones of dense DE. Egms were less fractionated, with longer CL and lower voltage at dense DE versus non-DE regions: CFEmean: 97 ms versus 76 ms, p < 0.0001; local CL: 153 ms versus 143 ms, p < 0.0001; mean voltage: 0.63 mV versus 0.86 mV, p < 0.0001. Conclusions Atrial fibrosis as defined by DE MRI is associated with slower and more organized electrical activity but with lower voltage than healthy atrial areas. Ninety percent of continuous CFAE sites occur at non-DE and patchy DE LA sites. These findings are important when choosing the ablation strategy in persistent AF. (C) 2013 by the American College of Cardiology Foundation

引用

页码：802 / 812

页数：11

共 23 条

[1] Electropathological Substrate of Long-Standing Persistent Atrial Fibrillation in Patients With Structural Heart Disease [J].

Allessie, Maurits A. ;

de Groot, Natasja M. S. ;

Houben, Richard P. M. ;

Schotten, Ulrich ;

Boersma, Eric ;

Smeets, Joep L. ;

Crijns, Harry J. .

CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2010, 3 (06) :606-615

[2] Myocyte changes and their left atrial distribution in patients with chronic atrial fibrillation related to mitrat valve disease [J].

Corradi, D ;

Callegari, S ;

Benussi, S ;

Maestri, R ;

Pastori, P ;

Nascimbene, S ;

Bosio, S ;

Dorigo, E ;

Grassani, C ;

Rusconi, R ;

Vettori, MV ;

Alinovi, R ;

Astorri, E ;

Pappone, C ;

Alfieri, O .

HUMAN PATHOLOGY, 2005, 36 (10) :1080-1089

[3] Noninvasive Characterization of Epicardial Activation in Humans With Diverse Atrial Fibrillation Patterns [J].

Cuculich, Phillip S. ;

Wang, Yong ;

Lindsay, Bruce D. ;

Faddis, Mitchell N. ;

Schuessler, Richard B. ;

Damiano, Ralph J., Jr. ;

Li, Li ;

Rudy, Yoram .

CIRCULATION, 2010, 122 (14) :1364-+

[4] Association of Left Atrial Fibrosis Detected by Delayed-Enhancement Magnetic Resonance Imaging and the Risk of Stroke in Patients With Atrial Fibrillation [J].

Daccarett, Marcos ;

Badger, Troy J. ;

Akoum, Nazem ;

Burgon, Nathan S. ;

Mahnkopf, Christian ;

Vergara, Gaston ;

Kholmovski, Eugene ;

McGann, Christopher J. ;

Parker, Dennis ;

Brachmann, Johannes ;

MacLeod, Rob S. ;

Marrouche, Nassir F. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2011, 57 (07) :831-838

[5] The Pathophysiologic Basis of Fractionated and Complex Electrograms and the Impact of Recording Techniques on Their Detection and Interpretation [J].

de Bakker, Jacques M. T. ;

Wittkampf, Fred H. M. .

CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2010, 3 (02) :204-213

[6] Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins [J].

Haïssaguerre, M ;

Jaïs, P ;

Shah, DC ;

Takahashi, A ;

Hocini, M ;

Quiniou, G ;

Garrigue, S ;

Le Mouroux, A ;

Le Métayer, P ;

Clémenty, J .

NEW ENGLAND JOURNAL OF MEDICINE, 1998, 339 (10) :659-666

[7] Atrial fibrillatory cycle length: computer simulation and potential clinical importance [J].

Haissaguerre, Michel ;

Lim, Kang-Teng ;

Jacquemet, Vincent ;

Rotter, Martin ;

Dang, Lam ;

Hocini, Meleze ;

Matsuo, Seiichiro ;

Knecht, Sebastian ;

Jais, Pierre ;

Virag, Nathatlie .

EUROPACE, 2007, 9 :64-70

[8] Noninvasive Panoramic Mapping of Human Atrial Fibrillation Mechanisms: A Feasibility Report [J].

Haissaguerre, Michel ;

Hocini, Meleze ;

Shah, Ashok J. ;

Derval, Nicolas ;

Sacher, Frederic ;

Jais, Pierre ;

Dubois, Remi .

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2013, 24 (06) :711-717

[9] Functional Nature of Electrogram Fractionation Demonstrated by Left Atrial High-Density Mapping [J].

Jadidi, Amir S. ;

Duncan, Edward ;

Miyazaki, Shinsuke ;

Lellouche, Nicolas ;

Shah, Ashok J. ;

Forclaz, Andrei ;

Nault, Isabelle ;

Wright, Matthew ;

Rivard, Lena ;

Liu, Xingpeng ;

Scherr, Daniel ;

Wilton, Stephen B. ;

Sacher, Frederic ;

Derval, Nicolas ;

Knecht, Sebastien ;

Kim, Steven J. ;

Hocini, Meleze ;

Narayan, Sanjiv ;

Haissaguerre, Michel ;

Jais, Pierre .

CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2012, 5 (01) :32-U104

[10] Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation [J].

Jais, P ;

Haissaguerre, M ;

Shah, DC ;

Chouairi, S ;

Clementy, J .

PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1996, 19 (11) :1998-2003

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