Abstract：
BACKGROUND: Atrial myopathy may underlie the progression of atrial fibrillation (AF) from a treatable disease to an irreversible condition with poor ablation outcomes. Electrophysiological methods to unmask areas prone to re-entry initiation could be key to defining latent atrial myopathy.
METHODS: Consecutive patients referred for AF ablation were prospectively included at four institutions. Decrement evoked potential mapping (DEEP) was performed in eight left atrial sites and five right atrial sites, from two different pacing locations (endocardially from the left atrial appendage, epicardially from the proximal coronary sinus). The electrograms (EGMs) during S1 600 ms drive and after an extra stimulus (S2 at +30 ms above atrial refractoriness) were studied at each location and assessed for decremental properties. Follow-up was 12 months.
RESULTS: Seventy-four patients were included and 85% had persistent AF. A total of 17,614 EGMs were individually analysed and measured. Nine percent of the EGMs showed DEEP properties (local delay of >10 ms after S2) with a mean decrement of 33±26 ms. DEEPs were more frequent in the left atrium than the right atrium (9.4% vs 8.0%; p<0.001) and more prevalent in persistent AF patients than paroxysmal AF patients (9.8% vs 4.6% p=0.001). Atrial DEEPs were more frequently unmasked in normal bipolar voltage areas and by epicardial pacing than endocardial pacing (9.6% vs 8.4%, respectively; p=0.004). Within the left atrium, the roof had the highest prevalence of DEEP EGMs.
CONCLUSIONS: DEEP mapping of both atria is useful for highlighting areas with a tendency for unidirectional block and re-entry initiation. Those areas are more easily unmasked by epicardial pacing from the coronary sinus and more prevalent in persistent AF patients than in paroxysmal AF patients.
METHODS: Consecutive patients referred for AF ablation were prospectively included at four institutions. Decrement evoked potential mapping (DEEP) was performed in eight left atrial sites and five right atrial sites, from two different pacing locations (endocardially from the left atrial appendage, epicardially from the proximal coronary sinus). The electrograms (EGMs) during S1 600 ms drive and after an extra stimulus (S2 at +30 ms above atrial refractoriness) were studied at each location and assessed for decremental properties. Follow-up was 12 months.
RESULTS: Seventy-four patients were included and 85% had persistent AF. A total of 17,614 EGMs were individually analysed and measured. Nine percent of the EGMs showed DEEP properties (local delay of >10 ms after S2) with a mean decrement of 33±26 ms. DEEPs were more frequent in the left atrium than the right atrium (9.4% vs 8.0%; p<0.001) and more prevalent in persistent AF patients than paroxysmal AF patients (9.8% vs 4.6% p=0.001). Atrial DEEPs were more frequently unmasked in normal bipolar voltage areas and by epicardial pacing than endocardial pacing (9.6% vs 8.4%, respectively; p=0.004). Within the left atrium, the roof had the highest prevalence of DEEP EGMs.
CONCLUSIONS: DEEP mapping of both atria is useful for highlighting areas with a tendency for unidirectional block and re-entry initiation. Those areas are more easily unmasked by epicardial pacing from the coronary sinus and more prevalent in persistent AF patients than in paroxysmal AF patients.
摘要：
背景：心房肌病可能是心房颤动（AF）从可治疗的疾病发展为消融效果较差的不可逆疾病的基础。揭开易于重新进入的区域的电生理方法可能是定义潜伏性心房肌病的关键。
方法：前瞻性地纳入了4个机构的连续房颤消融患者。在八个左心房部位和五个右心房部位进行减量诱发电位标测(DEEP),来自两个不同的起搏位置(左心耳,心外膜从近端冠状窦）。在每个位置研究了S1600ms驱动期间和额外刺激（心房不应度以上30ms处的S2）后的电描记图（EGM），并评估了其衰减特性。随访12个月。
结果：纳入74例患者，85%的患者有持续性房颤。对总共17,614个EGM进行了单独分析和测量。9％的电描记图显示DEEP特性（S2后局部延迟>10ms），平均衰减量为33±26ms。左心房DEEP发生率高于右心房(9.4%vs8.0%;p<0.001),持续性房颤患者发生率高于阵发性房颤患者(9.8%vs4.6%p=0.001)。心房DEEP在正常双极电压区域和心外膜起搏比心内膜起搏更常见(9.6%vs8.4%,分别为；p=0.004)。在左心房内，
结论:两个心房的DEEP标测对于突出显示有单向传导阻滞和重新进入起始倾向的区域是有用的.与阵发性房颤患者相比，这些区域更容易被冠状窦的心外膜起搏所掩盖，并且在持续性房颤患者中更为普遍。
方法：前瞻性地纳入了4个机构的连续房颤消融患者。在八个左心房部位和五个右心房部位进行减量诱发电位标测(DEEP),来自两个不同的起搏位置(左心耳,心外膜从近端冠状窦）。在每个位置研究了S1600ms驱动期间和额外刺激（心房不应度以上30ms处的S2）后的电描记图（EGM），并评估了其衰减特性。随访12个月。
结果：纳入74例患者，85%的患者有持续性房颤。对总共17,614个EGM进行了单独分析和测量。9％的电描记图显示DEEP特性（S2后局部延迟>10ms），平均衰减量为33±26ms。左心房DEEP发生率高于右心房(9.4%vs8.0%;p<0.001),持续性房颤患者发生率高于阵发性房颤患者(9.8%vs4.6%p=0.001)。心房DEEP在正常双极电压区域和心外膜起搏比心内膜起搏更常见(9.6%vs8.4%,分别为；p=0.004)。在左心房内，
结论:两个心房的DEEP标测对于突出显示有单向传导阻滞和重新进入起始倾向的区域是有用的.与阵发性房颤患者相比，这些区域更容易被冠状窦的心外膜起搏所掩盖，并且在持续性房颤患者中更为普遍。
