基于心外膜标测技术的房颤表征方法及电生理机制研究
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摘要
心房颤动(简称房颤)是临床最常见的一种复杂心律失常。与其他医学研究不同的是,房颤治疗的发展是一个机制研究与临床研究并进的过程,期间伴随着标测工具的不断更新与发展。目前房颤药物治疗效果较差,非药物治疗的复发率较高,且手术有一定的风险,关键原因在于房颤的电生理机制尚未完全阐明。本研究主要在构建全心房心外膜标测的基础上,对房颤的电活动进行整体的连续跟踪;通过动物实验研究,初步探索房颤的发生和维持机制;通过房颤数据的表征方法研究及优化,希望为房颤的临床研究提供更丰富的信息。
本文首先概括了128道的全心房心外膜标测系统的研制,介绍了心外膜标测的相关技术。针对心外膜局部标测不能反映房颤时心房整体的复杂电活动情况,研制出128位点的全心房心外膜标测电极,建立了128道的全心房心外膜动态标测系统,可对肺静脉和心房的电活动进行直观的全面演示。动物实验结果证实这种便携式的全心房心外膜动态标测技术可实现多道心电同步连续采样和连续监测,对心房的电活动进行连续跟踪,满足现场实时采集和观测的需求。
本文分析了单双极复合利用提高标测精度的方法,利用基于该组合标测方法的64道心外膜标测系统,通过对局部心房外膜电活动的记录和分析,对房颤的表征方法进行了初步研究。除了常规的等时图,主要采用了动态等电位图(波动图)、散点图(矢量图的叠加),并对某些时段的心外膜电信号进行了统计处理,对窦性心律和房颤数据的这些信息表达作了详尽的描述。结果表明,利用波动图和矢量图可对房颤进行动态观测,通过统计图可得知房颤时心肌的激动规律,这可为临床上房颤的精密诊断和治疗提供理论依据。
本文通过将信息熵概念引入心外膜标测数据的信息表征研究,对心动周期的统计性质进行了定量的估计。从心动周期信息熵的空间分布图可直观快捷地了解到房颤活动的复杂度,验证了其中偏高区域具有异位兴奋灶或参与房颤折返的可能,可用于临床房颤射频消融治疗的靶点定位。结果表明,信息熵概念引入心外膜标测数据的分析可优化房颤的表征方法。
最后,本文开展了基于全心房心外膜标测的房颤电生理机制初步研究。利用标测数据研究了房颤时心房外膜不同部位的平均房颤周长(AFCL)分布情况,初步探讨了房颤的发生机制;通过实验数据分析了刺激脂肪垫迷走神经丛在肺静脉局灶性快速激动引发房颤中的作用。研究表明短阵猝发(burst)刺激诱发的房颤发生过程中肺静脉和心房各部位的AFCL呈现显著的梯度分布,其中肺静脉是激动频率最快的部位;心脏脂肪垫内迷走神经张力增高可能是肺静脉起源的阵发性房颤发生的基础;房颤持续和发展过程中有多种机制共同参与。该研究也证实了128道全心房心外膜标测系统在动物实验以及今后临床研究实际应用中的可行性。
本文研究显示,全心房心外膜标测技术有助于动物实验和临床实验对房颤机制进行更深层次的研究;开展标测数据的表征方法研究,可为房颤的电生理机制研究及临床上射频消融靶点的精确定位提供应用基础。
Atrial fibrillation (AF) is the most common complex arrhythmia in clinical practice. The development of the therapy of AF is different from other medical studies, because it exists concurrently with the mechanism study and mapping technique renovation. Nowadays the medication effects of AF are very poor. However the recurrence of non-medication is also a ubiquitous trend and has a high risk of dangerous during operation. The most important reason of this case is that the mechanisms of AF are not well understood. In this dissertation, a whole-atrial epicardial mapping system has been developed, which can detect the electrical activity on the epicardial surface of atrium and show epicardial electrical activity visually and comprehensively. Animal tests are performed to study the occurrence and maintenance mechanism of AF. Mapping data representation methods and its optimization is also described to offer more information to characterize AF in clinical practice.
Firstly, the development of 128-channel epicardial mapping system is introduced to explain the mapping technique. Because local epicardial mapping technique cannot show the complex electrical activity comprehensively during AF, 128-channel whole-atrial epicardial mapping system was constructed with 128-site epicardial mapping electrode patches. The system can directly show the epicardial electrical activities of pulmonary veins (PVs) and bi-atrium simultaneously. Animal tests proved that the system could describe the atrial electrical activity continuously by synchronous sample of multi-channel electrocardiogram (ECG) of epicardium. Result shows that this system can perform successfully in a surgical setting.
Combined unipolar and bipolar mapping technique for recording epicardial electrical activity was applied to detect the propagation of depolarization wave over the epicardium. It can improve the electrode efficiency and the precision in epicardial mapping. Initial study of mapping data representation on AF was performed with recorded data from local atrial epicardial surface. Besides traditional isochronal maps, other methods were used to express the characteristics of AF which including dynamic isopotential maps, scattergraph and some statistical graphs. All these maps were used to describe the electrical activity during sinus rhythm and AF. All kinds of maps were presented clearly and the activity of sinus rhythm or AF can be seen quite differently. The dynamic isopotential map and the scattergraph can display the active electrical conduction of the atrium. Furthermore statistical results are also very useful for analysis the exciting mode of AF. The results will help us to find the optimal technique to diagnose the foci of AF for clinical therapy.
Comentropy theory was applied to the study of data representation of AF through quantitative estimation of the statistical character of cardiac cycle. The spatial entropy distribution of cardiac cycle can reveal the complexity of electrical activity during AF and the regions with high value may be ectopic exciting foci or reentry paths. This study will be helpful for the radiofrequency ablation of AF. Result shows that methods for mapping data representation may be improved by comentropy theory.
Finally, initial study of the mechanisms of AF is performed based on whole-atrial epicardial mapping technique. The occurrence mechanism of AF was operated by measuring local AF cycle length (AFCL) of different sites that arranged all over the epicardial surface of PVs and bi-atrium. To investigate the effects of the fat pad on AF triggered by rapid exciting of PVs, whole-atrial epicardial ECGs after fat pad stimulation were studied. Results show that during AF there exists an AFCL gradient while the shortest AFCL is PV and enhanced spontaneous neural activity at cardiac fat pad may serve as a substrate for focal PV triggering AF. The development process of AF may involve many mechanisms that interact each other. It also shows that the whole-atrial epicardial mapping system described here may be a useful tool for animal tests and clinical study of AF.
Assembling the above-mentioned studies, the whole-atrial epicardial mapping technique will be helpful for the further investigation into the mechanisms of AF in animal tests and clinical research. Studies on mapping data representation may benefit the clinical basic research for mechanisms of AF and deciding the foci of AF undergoing radiofrequency ablation.
本文首先概括了128道的全心房心外膜标测系统的研制,介绍了心外膜标测的相关技术。针对心外膜局部标测不能反映房颤时心房整体的复杂电活动情况,研制出128位点的全心房心外膜标测电极,建立了128道的全心房心外膜动态标测系统,可对肺静脉和心房的电活动进行直观的全面演示。动物实验结果证实这种便携式的全心房心外膜动态标测技术可实现多道心电同步连续采样和连续监测,对心房的电活动进行连续跟踪,满足现场实时采集和观测的需求。
本文分析了单双极复合利用提高标测精度的方法,利用基于该组合标测方法的64道心外膜标测系统,通过对局部心房外膜电活动的记录和分析,对房颤的表征方法进行了初步研究。除了常规的等时图,主要采用了动态等电位图(波动图)、散点图(矢量图的叠加),并对某些时段的心外膜电信号进行了统计处理,对窦性心律和房颤数据的这些信息表达作了详尽的描述。结果表明,利用波动图和矢量图可对房颤进行动态观测,通过统计图可得知房颤时心肌的激动规律,这可为临床上房颤的精密诊断和治疗提供理论依据。
本文通过将信息熵概念引入心外膜标测数据的信息表征研究,对心动周期的统计性质进行了定量的估计。从心动周期信息熵的空间分布图可直观快捷地了解到房颤活动的复杂度,验证了其中偏高区域具有异位兴奋灶或参与房颤折返的可能,可用于临床房颤射频消融治疗的靶点定位。结果表明,信息熵概念引入心外膜标测数据的分析可优化房颤的表征方法。
最后,本文开展了基于全心房心外膜标测的房颤电生理机制初步研究。利用标测数据研究了房颤时心房外膜不同部位的平均房颤周长(AFCL)分布情况,初步探讨了房颤的发生机制;通过实验数据分析了刺激脂肪垫迷走神经丛在肺静脉局灶性快速激动引发房颤中的作用。研究表明短阵猝发(burst)刺激诱发的房颤发生过程中肺静脉和心房各部位的AFCL呈现显著的梯度分布,其中肺静脉是激动频率最快的部位;心脏脂肪垫内迷走神经张力增高可能是肺静脉起源的阵发性房颤发生的基础;房颤持续和发展过程中有多种机制共同参与。该研究也证实了128道全心房心外膜标测系统在动物实验以及今后临床研究实际应用中的可行性。
本文研究显示,全心房心外膜标测技术有助于动物实验和临床实验对房颤机制进行更深层次的研究;开展标测数据的表征方法研究,可为房颤的电生理机制研究及临床上射频消融靶点的精确定位提供应用基础。
Atrial fibrillation (AF) is the most common complex arrhythmia in clinical practice. The development of the therapy of AF is different from other medical studies, because it exists concurrently with the mechanism study and mapping technique renovation. Nowadays the medication effects of AF are very poor. However the recurrence of non-medication is also a ubiquitous trend and has a high risk of dangerous during operation. The most important reason of this case is that the mechanisms of AF are not well understood. In this dissertation, a whole-atrial epicardial mapping system has been developed, which can detect the electrical activity on the epicardial surface of atrium and show epicardial electrical activity visually and comprehensively. Animal tests are performed to study the occurrence and maintenance mechanism of AF. Mapping data representation methods and its optimization is also described to offer more information to characterize AF in clinical practice.
Firstly, the development of 128-channel epicardial mapping system is introduced to explain the mapping technique. Because local epicardial mapping technique cannot show the complex electrical activity comprehensively during AF, 128-channel whole-atrial epicardial mapping system was constructed with 128-site epicardial mapping electrode patches. The system can directly show the epicardial electrical activities of pulmonary veins (PVs) and bi-atrium simultaneously. Animal tests proved that the system could describe the atrial electrical activity continuously by synchronous sample of multi-channel electrocardiogram (ECG) of epicardium. Result shows that this system can perform successfully in a surgical setting.
Combined unipolar and bipolar mapping technique for recording epicardial electrical activity was applied to detect the propagation of depolarization wave over the epicardium. It can improve the electrode efficiency and the precision in epicardial mapping. Initial study of mapping data representation on AF was performed with recorded data from local atrial epicardial surface. Besides traditional isochronal maps, other methods were used to express the characteristics of AF which including dynamic isopotential maps, scattergraph and some statistical graphs. All these maps were used to describe the electrical activity during sinus rhythm and AF. All kinds of maps were presented clearly and the activity of sinus rhythm or AF can be seen quite differently. The dynamic isopotential map and the scattergraph can display the active electrical conduction of the atrium. Furthermore statistical results are also very useful for analysis the exciting mode of AF. The results will help us to find the optimal technique to diagnose the foci of AF for clinical therapy.
Comentropy theory was applied to the study of data representation of AF through quantitative estimation of the statistical character of cardiac cycle. The spatial entropy distribution of cardiac cycle can reveal the complexity of electrical activity during AF and the regions with high value may be ectopic exciting foci or reentry paths. This study will be helpful for the radiofrequency ablation of AF. Result shows that methods for mapping data representation may be improved by comentropy theory.
Finally, initial study of the mechanisms of AF is performed based on whole-atrial epicardial mapping technique. The occurrence mechanism of AF was operated by measuring local AF cycle length (AFCL) of different sites that arranged all over the epicardial surface of PVs and bi-atrium. To investigate the effects of the fat pad on AF triggered by rapid exciting of PVs, whole-atrial epicardial ECGs after fat pad stimulation were studied. Results show that during AF there exists an AFCL gradient while the shortest AFCL is PV and enhanced spontaneous neural activity at cardiac fat pad may serve as a substrate for focal PV triggering AF. The development process of AF may involve many mechanisms that interact each other. It also shows that the whole-atrial epicardial mapping system described here may be a useful tool for animal tests and clinical study of AF.
Assembling the above-mentioned studies, the whole-atrial epicardial mapping technique will be helpful for the further investigation into the mechanisms of AF in animal tests and clinical research. Studies on mapping data representation may benefit the clinical basic research for mechanisms of AF and deciding the foci of AF undergoing radiofrequency ablation.
引文
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