Spatial relationship of organized rotational and focal sources in human atrial fibrillation to autonomic ganglionated plexi

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:240

Article

Baykaner, Tina¹  Zografos, Theodoros A.²  Zaman, Junaid A. B.³  Pantos, Ioannis²  Alhusseini, Mahmood¹  Navara, Rachita¹  Krummen, David E.⁴  Narayan, Sanjiv M.¹  Katritsis, Demosthenes G.^2,5 

[1] Stanford Univ, Div Cardiol, Stanford, CA 94305 USA

[2] Athens Euroclin, Dept Cardiol, Athens, Greece

[3] Imperial Coll, London, England

[4] Univ Calif San Diego, San Diego, CA 92103 USA

[5] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Boston, MA USA

关键词: Atrial fibrillation;    Ablation;    Rotor;    Autonomic nervous system;    Ganglionated plexi;   

DOI  :  10.1016/j.ijcard.2017.02.152

来源: Elsevier

【 摘 要 】

Background: One approach to improve ablation for atrial fibrillation (AF) is to focus on physiological targets including focal or rotational sources or ganglionic plexi (GP). However, the spatial relationship between these potential mechanisms has never been studied. We tested the hypothesis that rotors and focal sources for AF may colocalize with ganglionated plexi (GP). Methods: We prospectively identified locations of AF rotors and focal sources, and correlated these to GP sites in 97 consecutive patients (age 59.9 +/- 11.4, 73% persistent AF). AF was recorded with 64-pole catheters with activation/phase mapping, and related to anatomic GP sites on electroanatomic maps. Results: AF sources arose in 96/97 (99%) patients for 2.6 +/- 1.4 sources per patient (left atrium: 1.7 +/- 0.9 right atrium: 1.1 +/- 0.8), eachwith an area of 2-3 cm(2). On area analyses, the probability of an AF source randomly overlapping a GP area was 26%. Left atrial sources were seen in 94 (97%) patients, in whom >= 1 source co-localized with GP in 75 patients (80%; p < 0.05). AF sources were more likely to colocalize with left vs right GPs (p < 0.05), and colocalization was more likely in patients with higher CHADS2VASc scores (age > 65, diabetes; p< 0.05). Conclusions: This is the first study to demonstrate that clinically detected AF focal and rotational sources in the left atrium often colocalize with regions of autonomic innervation. Studies should define if the role of AF sources differs by their anatomical location. (C) 2017 Elsevier B.V. All rights reserved.

【 授权许可】

Free