Relationship between High-Dominant Frequency Sites and the Impact of a Stepwise Linear Ablation on the Distribution of Complex Fractionated Electrograms
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概要
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<B>Background:</B> Complex fractionated electrograms (CFE) and high-dominant frequency (DF) sites are considered to be maintainers of atrial fibrillation (AF). The purpose of this study was to determine the relationship between high-DF sites in the left atrium (LA) and the impact of a stepwise linear ablation in patients with AF. <B>Methods:</B> We compared LA-CFEs and DF maps acquired using NavX system before and after ablation in 30 AF patients (non-paroxysmal: 20). The maps were constructed from bipolar electrograms acquired from circular catheter during AF. The stepwise approach initially utilized a circumferential pulmonary vein isolation, followed by linear lesions including at the septum, roof, mitral annulus and ridge of the appendage. <B>Results:</B> A mean of 282±60 points were sampled. Multipolar-catheter mapping identified sites with high-DF (>9 Hz) in all patients (7.9±2.8/patient). Sixty-five% of the high-DF sites were on or adjacent to the ablation line. There was a significant reduction in the CFE burden after the stepwise ablation for both the regions with <120 ms (90% vs. 49%; P<.001) and <50 ms (65% vs. 8%; P<.0001), with a decrease in both the DF within the CS (7.0±1.3 vs. 5.1±1.1 Hz; P<.01) and CFE-surface area (44.2±21.5 vs. 6.0±5.3 cm<SUP>2</SUP>; P<.0001). <B>Conclusion:</B> Stepwise linear ablation lines have a higher incidence of neighboring high-DF sites, and this may be related to eliminating the majority of the CFE areas after the procedure. These findings have important implications for the substrate-based ablation strategies for AF.
著者
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Takayanagi Kan
Department Of Cardiology Dokkyo Medical University Koshigaya Hospital
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Nakahara Shiro
Department Of Cardiology Dokkyo Medical University Koshigaya Hospital
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Sakai Yoshihiko
Department Of Cardiology Dokkyo Medical University Koshigaya Hospital
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Toratani Noritaka
Department Of Cardiology Dokkyo University Koshigaya Hospital
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Toratani Noritaka
Department of Cardiology, Dokkyo University Koshigaya Hospital
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Takayanagi Kan
Department of Cardiology, Dokkyo University Koshigaya Hospital
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Higashi Akihiro
Department of Cardiology, Dokkyo University Koshigaya Hospital
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Sakai Yoshihiko
Department of Cardiology, Dokkyo University Koshigaya Hospital
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