Deconstructing complex fractionated atrial electrograms: Just how complex and fractionated are they?

心房颤动 医学 肺静脉 导管消融 烧蚀 心脏病学 内科学 窦性心律
作者
Aman Chugh
出处
期刊:Heart Rhythm [Elsevier BV]
卷期号:8 (2): 254-255 被引量:1
标识
DOI:10.1016/j.hrthm.2010.11.021
摘要

Few topics in clinical electrophysiology evoke as much controversy as that of complex fractionated atrial electrograms (CFAEs). The original description by Nademanee et al 1 Nademanee K. McKenzie J. Kosar E. et al. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol. 2004; 43: 2044-2053 Google Scholar offered electrophysiologists a tool by which to map and ablate the atrial “substrate” in patients with atrial fibrillation (AF). Subsequent studies have reached disparate conclusions, with some suggesting that ablation of CFAEs has a role in patients with persistent AF 2 Haissaguerre M. Hocini M. Sanders P. et al. Catheter ablation of long-lasting persistent atrial fibrillation: clinical outcome and mechanisms of subsequent arrhythmias. J Cardiovasc Electrophysiol. 2005; 16: 1138-1147 Google Scholar , 3 Elayi C.S. Verma A. Di Biase L. et al. Ablation for longstanding permanent atrial fibrillation: results from a randomized study comparing three different strategies. Heart Rhythm. 2008; 5: 1658-1664 Google Scholar and others not. 4 Oral H. Chugh A. Yoshida K. et al. A randomized assessment of the incremental role of ablation of complex fractionated atrial electrograms after antral pulmonary vein isolation for long-lasting persistent atrial fibrillation. J Am Coll Cardiol. 2009; 53: 782-789 Google Scholar Apart from the lack of consensus in the literature, there is no universal definition of what constitutes a CFAE. Furthermore, a CFAE may be generated by a variety of mechanisms, all of which may not be critical to the fibrillatory process. These complex electrograms may be found at areas of slow conduction, 5 Konings K.T. Smeets J.L. Penn O.C. Wellens H.J. Allessie M.A. Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. Circulation. 1997; 95: 1231-1241 Google Scholar pivot point of turning wavelets, wave collision, fibrillatory conduction, 6 Vaquero M. Calvo D. Jalife J. Cardiac fibrillation: from ion channels to rotors in the human heart. Heart Rhythm. 2008; 5: 872-879 Google Scholar rotor meandering, 7 Zlochiver S. Yamazaki M. Kalifa J. Berenfeld O. Rotor meandering contributes to irregularity in electrograms during atrial fibrillation. Heart Rhythm. 2008; 5: 846-854 Google Scholar or autonomic activation. 8 Lu Z. Scherlag B.J. Lin J. et al. Autonomic mechanism for complex fractionated atrial electrograms: evidence by fast fourier transform analysis. J Cardiovasc Electrophysiol. 2008; 19: 835-842 Google Scholar Currently it is not possible to predict prior to ablation whether a given CFAE is being generated by a driver source versus a bystander site. This is an important point because excessive ablation not only is time consuming but also may be associated with acute and long-term complications such as atrial scarring 9 Chan C.P. Wong W.S. Pumprueg S. et al. Inadvertent electrical isolation of the left atrial appendage during catheter ablation of persistent atrial fibrillation. Heart Rhythm. 2010; 7: 173-180 Google Scholar and impairment of atrial mechanical function. To add to this conundrum, a recent study questioned the validity of sequential mapping of CFAEs on the basis of their temporal variability. 10 Habel N. Znojkiewicz P. Thompson N. et al. The temporal variability of dominant frequency and complex fractionated atrial electrograms constrains the validity of sequential mapping in human atrial fibrillation. Heart Rhythm. 2010; 7: 586-593 Google Scholar Classifying fractionated electrograms in human atrial fibrillation using monophasic action potentials and activation mapping: Evidence for localized drivers, rate acceleration, and nonlocal signal etiologiesHeart RhythmVol. 8Issue 2PreviewComplex fractionated electrograms (CFAEs) detected during substrate mapping for atrial fibrillation (AF) reflect etiologies that are difficult to separate. Without knowledge of local refractoriness and activation sequence, CFAEs may represent rapid localized activity, disorganized wave collisions, or far-field electrograms. Full-Text PDF
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
刚刚
XIAO完成签到,获得积分10
1秒前
万能图书馆应助在途中采纳,获得10
2秒前
个性的傲安完成签到,获得积分10
2秒前
UniTTEC9560完成签到,获得积分10
2秒前
3秒前
无语的沛春完成签到,获得积分10
3秒前
shinble完成签到 ,获得积分10
4秒前
杨大大完成签到 ,获得积分10
4秒前
4秒前
4秒前
柒柒完成签到,获得积分10
4秒前
zhenzhen完成签到,获得积分10
4秒前
甜甜友容完成签到,获得积分10
5秒前
5秒前
xueerbx完成签到,获得积分0
5秒前
又又完成签到,获得积分10
6秒前
细腻海蓝发布了新的文献求助10
6秒前
优雅友蕊完成签到,获得积分10
6秒前
abcd_1067完成签到,获得积分10
6秒前
yufan应助JEWEL采纳,获得10
6秒前
7秒前
十一玮发布了新的文献求助10
8秒前
活泼新儿完成签到 ,获得积分10
9秒前
沙与沫完成签到 ,获得积分10
9秒前
勤恳怀梦完成签到,获得积分10
9秒前
不爱吃饭发布了新的文献求助10
9秒前
小章鱼完成签到,获得积分10
9秒前
10秒前
Bedivere发布了新的文献求助10
10秒前
11秒前
lily发布了新的文献求助10
11秒前
Bryan应助你在烦恼什么采纳,获得10
11秒前
尊敬雪萍发布了新的文献求助10
11秒前
QQ发布了新的文献求助10
11秒前
乖猫要努力应助李傲采纳,获得10
12秒前
勤奋完成签到,获得积分0
12秒前
12秒前
宇宇宇c完成签到,获得积分10
13秒前
CodeCraft应助王铂然采纳,获得10
13秒前
高分求助中
Nickel, Cobalt and Palladium Catalysed Infarction with Ventricular following rich structural diversity 1000
A new approach to the extrapolation of accelerated life test data 1000
Cognitive Neuroscience: The Biology of the Mind 1000
Technical Brochure TB 814: LPIT applications in HV gas insulated switchgear 1000
Immigrant Incorporation in East Asian Democracies 600
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3968608
求助须知:如何正确求助?哪些是违规求助? 3513486
关于积分的说明 11168243
捐赠科研通 3248926
什么是DOI,文献DOI怎么找? 1794540
邀请新用户注册赠送积分活动 875188
科研通“疑难数据库(出版商)”最低求助积分说明 804676