3차원 Non-Contact Mapping으로 관찰한 심방세동의 유발 및 지속의 기전

초록

Background and Objectives：We undertook this study to assess the initiation and maintenance mechanisms ofatrial fibrillation (AF) and their relationships with the anatomical structures of the left atrium (LA) and pulmonaryveins (PVs). Subjects and Methods：Thirty-seven patients (33 men, mean age 50, range 25-68 years) with paroxysmalAF (n=29) and persistent AF (n=8) who underwent mapping of the LA and PV using 3D non-contactendocardial mapping system (EnSite 3000) were enrolled. The multielectrode array and ablation catheter werepositioned in the LA via the double transseptal approach. Atrial premature beats (APBs) which triggered initiationof AF that lasted longer than 1 min were mapped and the activation sequence was analyzed on isopotential colormaps. Wave front dynamics and the relationship with the underlying structures were assessed. Results：Morethan half, 56.4%, of APBs from PV were related to the initiation of AF, but not related to the maintenance of AF.A quarter, 25.6%, of APBs from PV not only initiated AF, but also maintained AF without continuous triggering.Mixed type and indeterminate type of AF was 5.0% and 12.8%, respectively. During AF, the mean number ofwavelets was 1.45 (maximum 3 in 76.5%). Anatomical structures showing slow conduction and wavebreakswere mostly located at the septopulmonary bundle (86.5%) and the posterior roof of the LA between the leftsuperior PV and right superior PV (54.1%). Conclusion：Focal repetitive activity from PV played an importantrole in both the initiation and maintenance of AF. Specific anatomical structures such as septopulmonary bundleor posterior roof of the LA were related to the heterogeneous conduction delay and spontaneous wavebreak,which was also important in the maintenance of AF.

키워드