Impact of anisotropic conduction and premature atrial contraction on the fractionated atrial potentials

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Arrhythmia Pub Date : 2024-10-09 DOI:10.1002/joa3.13161
Hideko Toyama MD, PhD, Koichiro Kumagai MD, PhD
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Abstract

Background

Fractionated atrial potential (FAP) during sinus rhythm (SR) may be a new target for ablation of atrial fibrillation (AF). However, the effects of the direction of activation and premature atrial contraction (PAC) on FAP is unknown. Therefore, we examined the impact of anisotropic conduction and PAC on the distribution and areas of FAP.

Methods

FAP map in the left atrium was created in 40 patients with AF before ablation. The distribution and areas of FAP were compared during SR, distal coronary sinus (CS) pacing (S1) and extrastimulus (S2), and paced PAC after SR. FAP was defined as a potential with four or more fragmented deflections.

Results

FAPs during SR were found in the right and mid-anterior walls and septum in most patients. During S1 compared to SR, FAPs significantly decreased in the right and mid-anterior walls, appendage, septum, and right inferior wall, while significantly increased in the lateral wall. During S2 compared to S1, FAPs significantly increased in the mid anterior and right and mid posterior walls. During PAC compared to SR, FAPs significantly decreased in the right and mid anterior walls and roof, while significantly increased in the left anterior, left inferior and lateral walls. A rotational activation pattern at the FAP area during CS pacing was observed in 12 patients (30%), mostly in the left inferior wall.

Conclusions

The distribution and areas of FAP vary with anisotropic conduction and extrastimulus. Therefore, FAP should be evaluated not only during SR but also during extrastimulus from the distal CS.

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各向异性传导和心房早缩对分房电位的影响。
背景:窦性心律(SR)期间的分异心房电位(FAP)可能是心房颤动(AF)消融的新靶点。然而,激活方向和心房早缩(PAC)对FAP的影响尚不清楚。因此,我们研究了各向异性传导和PAC对FAP分布和面积的影响。方法:对40例房颤消融前左心房FAP图谱进行分析。在SR、远端冠状动脉窦(CS)起搏(S1)和刺激外(S2)期间比较FAP的分布和面积,并将SR后的起搏PAC定义为具有四个或更多碎片化偏转的电位。结果:大多数患者在SR过程中发现右前壁、中前壁和中隔存在FAPs。S1期与SR期相比,右侧和中前壁、附属物、隔膜和右侧下壁的FAPs明显减少,而侧壁的FAPs明显增加。与S1相比,S2期间,FAPs在中前壁、右壁和中后壁显著增加。PAC与SR相比,右、中前壁和顶部FAPs明显减少,左前壁、左下壁和外侧壁FAPs明显增加。在CS起搏期间,12例(30%)患者观察到FAP区域的旋转激活模式,主要在左下壁。结论:FAP的分布和面积随各向异性传导和外刺激而变化。因此,FAP不仅应在SR期间评估,还应在远端CS的外刺激期间评估。
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来源期刊
Journal of Arrhythmia
Journal of Arrhythmia CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.90
自引率
10.00%
发文量
127
审稿时长
45 weeks
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