未经证实:据报道,进行性心房纤维化重塑与心房心肌病(ACM)以及从阵发性房颤到持续性房颤(AF)的转变有关。我们试图确定参与心房重构的促进房颤持续性的解剖/结构和电生理因素。
UNASSIGNED:包括连续出现阵发性(n=134)或持续性(n=136)房颤的患者,并进行首次房颤消融术。患者在窦性心律(SR)期间接受了左心房(LA)高清标测(1,835±421个部位/图),并被随机分配到训练和验证集以进行模型开发和评估。从电解剖标测和非侵入性基线数据中总共提取了62个参数,包括四个主要类别:(1)LA大小,(2)低电压衬底(LVS)的范围,(3)LA电压和(4)双心房传导时间,由数字12导联ECG中放大的P波(APWD)的持续时间确定。进行了最小绝对收缩和选择算子(LASSO)和逻辑回归,以确定与每个类别和所有类别的房颤持续性最相关的因素。已开发的房颤持续性诊断模型的性能在鉴别方面得到了验证,校准和临床有用性。此外,还评估了HATCH评分和C2HEST评分在鉴别房颤持续性方面的表现。
UNASSIGNED:在训练和验证集中,APWD(阈值151ms),LA音量(LAV,阈值94毫升),双极LVS面积<1.0mV(阈值4.55cm2)和LA全局平均电压(GMV,阈值1.66mV)被确定为相应类别中AF持久性的最佳决定因素。此外,与LVS程度(AUC0.783和0.682)和GMV(AUC0.751和0.707)相比,APWD(AUC0.851和0.801)和LA体积(AUC0.788和0.741)在AF类型之间实现了更好的区分。整合模型(组合APWD和LAV)产生AF类型之间的最佳辨别性能(训练集中的AUC0.876和验证集中的0.830)。相比之下,在目前的研究中,HATCH评分和C2HEST评分仅在识别持续性房颤个体时达到AUC<0.60。
未经证实:在62个电解剖参数中,我们确认了APWD,洛杉矶卷,LVS范围,和平均左心房电压是与房颤持续性最相关的四个决定电生理和结构因素。值得注意的是,APWD与LA音量的组合使得能够以高精度区分阵发性和持续性AF,强调它们作为持续性房颤潜在基质的重要性。
UNASSIGNED: Progressive atrial fibrotic remodeling has been reported to be associated with atrial cardiomyopathy (ACM) and the transition from paroxysmal to persistent atrial fibrillation (AF). We sought to identify the anatomical/structural and electrophysiological factors involved in atrial remodeling that promote AF persistency.
UNASSIGNED: Consecutive patients with paroxysmal (n = 134) or persistent (n = 136) AF who presented for their first AF ablation procedure were included. Patients underwent left atrial (LA) high-definition mapping (1,835 ± 421 sites/map) during sinus rhythm (SR) and were randomized to training and validation sets for model development and evaluation. A total of 62 parameters from both electro-anatomical mapping and non-invasive baseline data were extracted encompassing four main categories: (1) LA size, (2) extent of low-voltage-substrate (LVS), (3) LA voltages and (4) bi-atrial conduction time as identified by the duration of amplified P-wave (APWD) in a digital 12-lead-ECG. Least absolute shrinkage and selection operator (LASSO) and logistic regression were performed to identify the factors that are most relevant to AF persistency in each category alone and all categories combined. The performance of the developed models for diagnosis of AF persistency was validated regarding discrimination, calibration and clinical usefulness. In addition, HATCH score and C2HEST score were also evaluated for their performance in identification of AF persistency.
UNASSIGNED: In training and validation sets, APWD (threshold 151 ms), LA volume (LAV, threshold 94 mL), bipolar LVS area < 1.0 mV (threshold 4.55 cm2) and LA global mean voltage (GMV, threshold 1.66 mV) were identified as best determinants for AF persistency in the respective category. Moreover, APWD (AUC 0.851 and 0.801) and LA volume (AUC 0.788 and 0.741) achieved better discrimination between AF types than LVS extent (AUC 0.783 and 0.682) and GMV (AUC 0.751 and 0.707). The integrated model (combining APWD and LAV) yielded the best discrimination performance between AF types (AUC 0.876 in training set and 0.830 in validation set). In contrast, HATCH score and C2HEST score only achieved AUC < 0.60 in identifying individuals with persistent AF in current study.
UNASSIGNED: Among 62 electro-anatomical parameters, we identified APWD, LA volume, LVS extent, and mean LA voltage as the four determinant electrophysiological and structural factors that are most relevant for AF persistency. Notably, the combination of APWD with LA volume enabled discrimination between paroxysmal and persistent AF with high accuracy, emphasizing their importance as underlying substrate of persistent AF.