Relationship Between Nonuniform Isochrone-Area in Late Activation Mapping and Arrhythmogenic Substrates Related to Atrial Fibrillation

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology Pub Date : 2026-10-13 Epub Date: 2026-06-30 DOI:10.1111/jce.70417

Tomonori Watanabe, Masashi Kamioka, Hisaki Makimoto, Takafumi Okuyama, Hiroaki Watanabe, Ayako Yokota, Takahiro Komori, Tomoyuki Kabutoya, Hitoshi Hachiya, Yasushi Imai, Kazuomi Kario

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引用次数: 0

Abstract

Introduction

Arrhythmogenic substrates within the atrial myocardium may contribute to the initiation of atrial fibrillation (AF). The relationship between nonuniform isochrone-areas in late activation mapping and arrhythmogenic substrates remains undetermined.

Methods

Sixty-two patients (66 ± 10 years, 47 males, non-paroxysmal AF [n = 30], second ablation procedure [n = 8]) who undergoing catheter ablation for AF were enrolled. High-density left atrial (LA) activation mapping was performed during atrial pacing after pulmonary vein (PV) isolation. Late activation mapping was retrospectively reconstructed. Nonuniform isochrone-areas were defined as regions of nonuniform and mottled conduction-zones characterized by the crowding of ≥ 3 color-isochrones within a 1-cm radius in late activation mapping. The relationship between nonuniform isochrone-areas and arrhythmogenic substrates associated with AF was evaluated.

Results

Non-PV triggers were identified in 11 patients (AF-triggers:12; short runs of premature atrial complexes:4), located in the LA wall (posterior:7; anterior:6; septum:2; roof:1). Patients with non-PV triggers had significantly more nonuniform isochrone-areas than those without (median [interquartile range] 5.0 [3.0–6.0] vs. 2.0 [1.0–4.0], p < 0.001). In multivariate logistic analysis for the presence of non-PV triggers, after adjusting for confounders such as non-paroxysmal AF, heart failure-history, and presence of low-voltage areas, the presence of nonuniform isochrone-areas on the LA low-posterior wall was an independent indicator for the presence of non-PV triggers (odds ratio: 6.9 [95% CI:1.1–44.1], p = 0.040). Of the 52 nonuniform isochrone-areas observed in the 11 patients with non-PV triggers, 20 areas corresponded to non-PV trigger sites.

Conclusion

Identification of nonuniform isochrone-areas located on LA low-posterior wall in late activation mapping may indicate the potential source for non-PV triggers.

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心房颤动相关致心律失常底物与晚期激活图非均匀等时区之间的关系。

心房心肌内的致心律失常底物可能有助于心房颤动（AF）的开始。晚期激活图谱中的非均匀等时区与致心律失常底物之间的关系尚不确定。方法：选取62例经导管消融治疗房颤的患者（66±10岁，男性47例，非阵发性房颤[n = 30]，第二次消融[n = 8]）。肺静脉（PV）隔离后，在心房起搏期间进行高密度左房（LA）激活测绘。回顾性重建晚期激活图谱。非均匀等时线区被定义为在激活后期作图中以1厘米半径内聚集≥3个颜色等时线为特征的非均匀和斑状导电带区域。评估了非均匀等时区与心房颤动相关的致心律失常底物之间的关系。结果：在11例患者中发现非pv触发因素（房颤触发因素：12例；早衰房颤短期发作：4例），位于左室壁（后壁：7例；前壁：6例；间隔：2例；顶壁：1例）。非pv触发器患者的非均匀等时区明显多于无pv触发器的患者（中位数[四分位数范围]5.0 [3.0-6.0]vs. 2.0 [1.0-4.0]）， p结论：在晚期激活映射中识别位于LA低后壁的非均匀等时区可能提示非pv触发器的潜在来源。

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 Cardiovascular Electrophysiology 医学-心血管系统

CiteScore

5.20

自引率

14.80%

发文量

433

审稿时长

3-6 weeks

期刊介绍： Journal of Cardiovascular Electrophysiology (JCE) keeps its readership well informed of the latest developments in the study and management of arrhythmic disorders. Edited by Bradley P. Knight, M.D., and a distinguished international editorial board, JCE is the leading journal devoted to the study of the electrophysiology of the heart.