Ablation in selective patients with long-standing persistent atrial fibrillation: medium-term results of the Dallas lesion set
Ablation in selective patients with long-standing persistent atrial fibrillation: medium-term results of the Dallas lesion set
复制标题
长期持续性心房颤动选择性患者的消融：达拉斯病变组的中期结果。
DOI：
10.1093/ejcts/ezt593
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发表时间：
2014-08-01
影响因子：
3.4
通讯作者：
Meng, Xu
中科院分区：
文献类型：
--
作者：
Wang, Jian-Gang;Xin, Meng;Meng, Xu
本研究的目的是研究模拟COX-迷宫III左房(LA)病变的Dallas病变集治疗长期持续性心房颤动(LSPAF)的有效性和安全性。在房顶、房顶前线、房顶与左心耳(LAA)之间形成线性损伤。所有患者均接受了神经节丛消融、左心耳切除和肺静脉隔离。随访6个月、12个月和24个月，采用动态心电图和实时三维超声心动图进行随访，随访24个月，83例(80.6%)患者无房性心律失常，其中77例(74.8%)停用抗心律失常药物。在3.1+/-0.7岁时，103例患者中74例(71.8%)为窦性心律，其中71例(68.9%)脱离AADS。左房内径判别房性心律失常复发的最佳界值为55 mm(受试者操作特征曲线分析)，Kaplan-Meier分析显示左房内径<55 mm的患者在随访期间复发率较低(LOG-RANK检验，P=0.015)。6个月后，无复发的患者左房体积显著减少，左房功能明显改善(P<；0.05)。相比之下，复发患者的左房体积或功能没有改善。Dallas病灶集是治疗LSPAF的有效方法。恢复窦性心律后，左房容量和功能均有明显改善。
The aim of the study was to investigate the efficacy and safety of the Dallas lesion set, which mimics the Cox-maze III left atrial (LA) lesions, for long-standing persistent atrial fibrillation (LSPAF).Over a 4-year period, 103 LSPAF patients were treated with the Dallas lesion set. Linear lesions were created at the roofline, at the anterior line and between the roofline and left atrial appendage (LAA). All patients underwent ganglionated plexi ablation and LAA excision as well as pulmonary vein isolation. Follow-up at 6, 12 and 24 months was performed by 48-h Holter recordings and real-time 3-dimensional echocardiography.At the 24-month follow-up, 83 of 103 (80.6%) patients were free of any atrial arrhythmia lasting > 30 s, with 77 patients (74.8%) off of antiarrhythmic drugs (AADs). At 3.1 +/- 0.7 years, 74 of 103 patients (71.8%) were in sinus rhythm, with 71 patients (68.9%) off AADs. The optimal cut-off value of LA dimension to discriminate atrial arrhythmia recurrence was 55 mm (receiver operating characteristic curve analysis), and the Kaplan-Meier analysis showed that patients with an LA dimension of < 55 mm had less recurrence during the follow-up (log-rank test, P = 0.015). After 6 months, a significant reduction in LA volume and improvement in LA function was noted in patients without recurrence (P < 0.05). In contrast, patients with recurrence showed no improvement in LA volume or function.The Dallas lesion set is an effective treatment in patients with LSPAF. It resulted in significant improvement in LA volume and function after restoration of sinus rhythm.