Benefits of Atrial Substrate Modification Guided by Electrogram Similarity and Phase Mapping Techniques to Eliminate Rotors and Focal Sources Versus Conventional Defragmentation in Persistent Atrial Fibrillation

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• 作者：Yenn-Jiang Lin ; MD ; PhD^a ; ^b ; ; Men-Tzung Lo ; PhD^c ; ^d ; Shih-Lin Chang ; MD^a ; ^b ; Li-Wei Lo ; MD^a ; ^b ; Yu-Feng Hu ; MD^a ; ^b ; Tze-Fan Chao ; MD^a ; ^b ; Fa-Po Chung ; MD^a ; ^b ; Jo-Nan Liao ; MD^a ; ^b ; Chin-Yu Lin ; MD^a ; ^b ; Huan-Yu Kuo^c ; ^d ; Yi-Chung Chang^e ; Chen Lin ; PhD^c ; ^d ; Ta-Chuan Tuan ; MD^a ; ^b ; Hsu-Wen Vincent Young ; PhD^d ; Kazuyoshi Suenari ; MD^b ; Van Buu Dan Do ; MD^b ; Suunu Budhi Raharjo ; MD^b ; Norden E. Huang ; PhD^d ; Shih-Ann Chen ; MD^a ; ^b ; ^{epsachen@ms41.hinet.net" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ablation ; atrial fibrillation ; electrogram ; rotor
• 刊名：JACC: Clinical Electrophysiology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：2
• 期：6
• 页码：667-678
• 全文大小：2664 K

文摘

This prospective study compared the efficacy of atrial substrate modification guided by a nonlinear phase mapping technique with that of conventional substrate ablation.

Background

The optimal ablation strategy for persistent atrial fibrillation (AF) was unknown.

Methods

In phase 1 study, we applied a cellular automation technique to simulate the electrical wave propagation to improve the phase mapping algorithm, involving analysis of high-similarity electrogram regions. In addition, we defined rotors and focal AF sources, using the physical parameters of the divergence and curvature forces. In phase 2 study, we enrolled 68 patients with persistent AF undergoing substrate modification into 2 groups, group-1 (n = 34) underwent similarity index (SI) and phase mapping techniques; group-2 (n = 34) received complex fractionated atrial electrogram ablation with commercially available software. Group-1 received real-time waveform similarity measurements in which a phase mapping algorithm was applied to localize the sources. We evaluated the single-procedure freedom from AF.

Results

In group-1, we identified an average of 2.6 ± 0.89 SI regions per chamber. These regions involved rotors and focal sources in 65% and 77% of patients in group-1, respectively. Group-1 patients had shorter ablation procedure times, higher termination rates, and significant reduction in AF recurrence compared to group-2 and a trend toward benefit for all atrial arrhythmias. Multivariate analysis showed that substrate mapping using nonlinear similarity and phase mapping was the independent predictor of freedom from AF recurrence (hazard ratio: 0.26; 95% confidence interval: 0.09 to 0.74; p = 0.01).

Conclusions

Our study showed that for persistent AF ablation, a specified substrate modification guided by nonlinear phase mapping could eliminate localized re-entry and non-pulmonary focal sources after pulmonary vein isolation.