Mechanisms of atrial fibrillation in mitral regurgitation patients: Insights from noninvasive electrocardiographic imaging

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology Pub Date : 2026-03-01 Epub Date: 2026-02-11 DOI:10.1016/j.jelectrocard.2026.154209

Ramya Vijayakumar PhD , Tari-Ann Yates MD , Martha McGilvray MD, MSt, MPHS , Nicholas Razo BS , Laurie A. Sinn BSN, RN , Richard B. Schuessler PhD , Christian W. Zemlin PhD , Yoram Rudy PhD , Ralph J. Damiano Jr. MD , Matthew R. Schill MD

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引用次数: 0

Abstract

Objective

Noninvasive Electrocardiographic Imaging (ECGI) was used to define the mechanisms of atrial fibrillation (AF) in mitral regurgitation (MR), which remain poorly understood.

Methods

Seventeen patients with degenerative MR and AF undergoing were studied. Thirteen age-matched patients with lone AF provided a control group. Epicardial electrograms were constructed noninvasively with ECGI using 256 body surface electrocardiograms and patient-specific heart-torso geometry from delayed-enhancement magnetic resonance imaging (DE-MRI) or computed tomography (CT) scans. Bi-atrial epicardial activation time maps and phase maps were generated. AF drivers were classified as focal (radial activation) or rotors (high curvature wavefront rotating about a center). Left atrial (LA) fibrosis was quantified from the DE-MRI scans in 5 MR patients.

Results

The LA and right atrium (RA) harbored 61% and 36% of drivers, respectively and the anterior inter-atrial groove had 3% of the sources. 51% of the drivers were mapped in the posterior LA. One third of drivers occurred repeatedly. The left PV and LA appendage regions had the most repetitive drivers. Activation patterns varied from single macro-reentry to simultaneous wavelets resulting in wave breaks and collisions. Driver distribution and activation patterns remained similar between MR and lone AF groups, except stable rotors were not observed in MR. DE-MRI maps showed bi-atrial fibrosis. Drivers and discontinuous wavefront propagation were often localized in fibrotic regions.

Conclusions

AF activation patterns in MR were complex and exhibited spatio-temporal variability. Bi-atrial drivers were present. The posterior LA harbored the highest percentage of drivers. This region also exhibited fibrosis in a subset of patients, suggesting that it may play a role in creating the AF substrate.

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二尖瓣返流患者心房颤动的机制：来自无创心电图成像的见解。

目的：无创心电图成像（ECGI）用于确定二尖瓣反流（MR）心房颤动（AF）的机制，这一机制尚不清楚。方法：对17例行退行性MR合并AF的患者进行分析。13例年龄匹配的单发房颤患者作为对照组。心外膜电图是用256个体表心电图和延迟增强磁共振成像（DE-MRI）或计算机断层扫描（CT）的患者特定心脏-躯干几何形状的ECGI无创构建的。生成双心房心外膜激活时间图和相图。自动对焦驱动分为聚焦驱动（径向激活）和旋翼驱动（围绕中心旋转的高曲率波前）。5例MR患者的左心房（LA）纤维化通过DE-MRI扫描进行量化。结果：左心房和右心房分别占61%和36%，前心房间沟占3%。51%的司机被映射到后LA。三分之一的司机反复发生。左PV和LA附属区有最多的重复驱动。激活模式多种多样，从单一的宏观再入到同时产生的小波，导致波浪破裂和碰撞。除了MR - DE-MRI图显示双心房纤维化未观察到稳定的转子外，MR组和单独心房颤动组之间的驱动器分布和激活模式保持相似。驱动器和不连续波前传播通常局限于纤维化区域。结论：MR中AF的激活模式复杂且具有时空变异性。双心房驱动者存在。洛杉矶后部的司机比例最高。该区域在一部分患者中也表现出纤维化，表明它可能在房颤底物的形成中发挥作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of electrocardiology 医学-心血管系统

CiteScore

2.70

自引率

7.70%

发文量

152

审稿时长

38 days

期刊介绍： The Journal of Electrocardiology is devoted exclusively to clinical and experimental studies of the electrical activities of the heart. It seeks to contribute significantly to the accuracy of diagnosis and prognosis and the effective treatment, prevention, or delay of heart disease. Editorial contents include electrocardiography, vectorcardiography, arrhythmias, membrane action potential, cardiac pacing, monitoring defibrillation, instrumentation, drug effects, and computer applications.