Benefits of Atrial Substrate Modification Guided by Electrogram Similarity and Phase Mapping Techniques to Eliminate Rotors and Focal Sources Versus Conventional Defragmentation in Persistent Atrial Fibrillation

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Title:	Benefits of Atrial Substrate Modification Guided by Electrogram Similarity and Phase Mapping Techniques to Eliminate Rotors and Focal Sources Versus Conventional Defragmentation in Persistent Atrial Fibrillation
Authors:	羅孟宗;Lin, Yenn-Jiang;Lo, Men-Tzung;Chang, Shih-Lin;Lo, Li-Wei;Hu, Yu-Feng;Chao, Tze-Fan;Chung, Fa-Po;Liao, Jo-Nan;Lin, Chin-Yu;Kuo, Huan-Yu;Chang, Yi-Chung;Lin, Chen;Tuan, Ta-Chuan;Vincent Young, Hsu-Wen;Suenari, Kazuyoshi;Dan Do, Van Buu;Raharjo, Suunu Budhi;Huang, Norden E.;Chen, Shih-Ann
Contributors:	生醫理工學院生醫科學與工程學系
Keywords:	ablation;atrial fibrillation;Cardiovascular;electrogram;rotor
Date:	2016-11-01
Issue Date:	2026-04-23 11:15:15 (UTC+8)
Publisher:	Elsevier USA;United States: Elsevier Inc
Abstract:	摘要： This prospective study compared the efficacy of atrial substrate modification guided by a nonlinear phase mapping technique with that of conventional substrate ablation. The optimal ablation strategy for persistent atrial fibrillation (AF) was unknown. In phase 1 study, we applied a cellular automation technique to simulate the electrical wave propagation to improve the phase mapping algorithm, involving analysis of high-similarity electrogram regions. In addition, we defined rotors and focal AF sources, using the physical parameters of the divergence and curvature forces. In phase 2 study, we enrolled 68 patients with persistent AF undergoing substrate modification into 2 groups, group-1 (n = 34) underwent similarity index (SI) and phase mapping techniques; group-2 (n = 34) received complex fractionated atrial electrogram ablation with commercially available software. Group-1 received real-time waveform similarity measurements in which a phase mapping algorithm was applied to localize the sources. We evaluated the single-procedure freedom from AF. In group-1, we identified an average of 2.6 ± 0.89 SI regions per chamber. These regions involved rotors and focal sources in 65% and 77% of patients in group-1, respectively. Group-1 patients had shorter ablation procedure times, higher termination rates, and significant reduction in AF recurrence compared to group-2 and a trend toward benefit for all atrial arrhythmias. Multivariate analysis showed that substrate mapping using nonlinear similarity and phase mapping was the independent predictor of freedom from AF recurrence (hazard ratio: 0.26; 95% confidence interval: 0.09 to 0.74; p = 0.01). Our study showed that for persistent AF ablation, a specified substrate modification guided by nonlinear phase mapping could eliminate localized re-entry and non-pulmonary focal sources after pulmonary vein isolation. [Display omitted] 其他題名： JACC Clin Electrophysiol 出版者： United States: Elsevier Inc 出版日期： 2016-11-01 出處： JACC. Clinical electrophysiology, 2016-11, Vol.2 (6), p.667-678 資源來源： Alma/SFX Local Collection 版權： 2016 American College of Cardiology Foundation 版權： American College of Cardiology Foundation 版權： Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. 識別號： ISSN: 2405-500X 識別號： ISSN: 2405-5018 識別號： EISSN: 2405-5018 識別號： DOI: 10.1016/j.jacep.2016.08.005 識別號： PMID: 29759744
Appears in Collections:	[Department of Biomedical Sciences and Engineering ] journal & Dissertation

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