目的:心房颤动(AF)是最常见的持续性心律失常,在美国影响超过230万人的中风,并且由于人口老龄化导致新的全球流行,患病率正在增加。肺静脉隔离(PVI)导管消融术终止房颤对于阵发性房颤是成功的,但由于目前的标测方法无法识别PVI区域以外的房颤活性底物,因此对于持续性房颤患者存在局限性。最近关于房颤病理生理学机制低估的证据表明,异位活动,具有纤颤传播的局部折返回路和多个回路重新进入都可能涉及人类AF。作者开发了新颖的电描记图分析方法,并使用来自孤立兔子心脏的光学映射数据进行了验证,以准确识别转子枢轴点。本研究的目的是评估使用新型电描记图分析方法,使用持续性房颤患者的心内电描记图,为导管消融过程中的指导生成患者特定的3D图的可行性。
方法:在IRB批准的情况下,招募临床预约进行房颤消融术的持续性房颤患者进行本研究。通过多尺度熵等新方法获得了整个左心房和右心房的1055个电描记图进行离线分析。多尺度频率,重现期密度熵,峰度和经验模式分解以生成患者特定的3D图。3D香农熵,为了进行比较,还生成了Renyi熵和主导频率图,以及局部激活时间和复杂的分馏电描记图分析图。
结果:获得了每种不同方法的患者特异性3D图。3D图指示PVI区域之外的潜在活性位点。然而,转子的存在无法确认,并且需要在更大的数据集上验证这些方法。
结论:传统的导管标测系统可用于生成患者特异性3D标测图,并使用新方法进行短时间序列分析。
OBJECTIVE: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia that causes stroke affecting more than 2.3 million people in the US and is increasing in prevalence due to ageing population causing a new global epidemic. Catheter ablation with pulmonary vein isolation (PVI) to terminate AF is successful for paroxysmal AF but suffers limitations with persistent AF patients as current mapping methods cannot identify AF active substrates outside of PVI region. Recent evidences in the mechanistic understating of AF pathophysiology suggest that ectopic activity, localized re-entrant circuit with fibrillatory propagation and multiple circuit re-entries may all be involved in human AF. The authors developed novel electrogram analysis methods and validated using optical mapping data from isolated rabbit hearts to accurately identify rotor pivot points. The purpose of this study was to assess the feasibility of generating patient-specific 3D maps for intraprocedural guidance for catheter ablation using intracardiac electrograms from a persistent AF patient using novel electrogram analysis methods.
METHODS: A persistent AF patient with clinical appointment for AF ablation was recruited for this study with IRB approval. 1055 electrograms throughout the left and right atrium were obtained for offline analysis with the novel approaches such as multiscale entropy, multiscale frequency, recurrence period density entropy, kurtosis and empirical mode decomposition to generate patient specific 3D maps. 3D Shannon Entropy, Renyi Entropy and Dominant frequency maps were also generated for comparison purposes along with local activation time and complex fractionated electrogram analysis maps.
RESULTS: Patient specific 3D maps were obtained for each of the different approach. The 3D maps indicate potential active sites outside the PVI region. However, presence of rotors cannot be confirmed and validation of these approaches is required on a larger dataset.
CONCLUSIONS: Conventional catheter mapping system can be used for generating patient specific 3D maps with short time series analysis using the novel approaches.