Technique and results of linear ablation at the mitral isthmus
Technique and results of linear ablation at the mitral isthmus
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DOI：
10.1161/01.cir.0000146917.75041.58
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发表时间：
2004-11-09
期刊：
影响因子：
37.8
通讯作者：
Haïssaguerre, M
中科院分区：
文献类型：
--
作者：
Jaïs, P;Hocini, M;Haïssaguerre, M
本前瞻性临床研究评估了线性二尖瓣峡部消融和肺静脉电隔离联合治疗阵发性房颤（AF）患者的可行性和有效性。（13名妇女;年龄55+/-10岁），药物难治性，对症状性阵发性房颤进行了肺静脉隔离，并对三尖瓣环峡部和二尖瓣峡部（左下肺静脉的二尖瓣环外侧）进行了线性消融。将其与100例连续患者（14例女性;年龄52 ± 10岁）进行比较，这些患者接受了肺静脉隔离和三尖瓣环消融术，未进行二尖瓣峡部消融术。通过证明（1）冠状窦（CS）起搏期间的双电位平行通道，（2）通过起搏线路两侧的激活迂回，以及（3）差异起搏技术，证实了双向二尖瓣峡部阻滞。所有患者均成功进行了肺静脉隔离和三尖瓣环峡部消融。92例患者在20+/-10分钟的心内膜射频应用后实现了二尖瓣峡部阻滞，68例患者在CS内额外应用5+/-4分钟的心外膜射频，导致CS起搏期间传导延迟151+/-26 ms。32例二尖瓣峡部消融患者与49例未消融患者相比，复发性房性心律失常（P=0.02）需要进一步消融。在最后一次手术后1年，87例二尖瓣峡部消融患者和69例未消融患者（P=0.002）在未使用抗心律失常药物的情况下无心律失常，二尖瓣峡部消融是与长期成功相关的唯一因素（房颤复发的RR，0.2; CI，0.1至0.4; P
Background-This prospective clinical study evaluates the feasibility and efficacy of combined linear mitral isthmus ablation and pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF).Methods and Results-One hundred consecutive patients (13 women; age 55+/-10 years) with drug-refractory, symptomatic paroxysmal AF underwent PV isolation and linear ablation of the cavotricuspid isthmus and the mitral isthmus ( lateral mitral annulus to the left inferior PV). They were compared with 100 consecutive patients ( 14 women; age, 52+/-10 years) undergoing PV isolation and cavotricuspid ablation without mitral isthmus ablation. Bidirectional mitral isthmus block was confirmed by demonstrating (1) a parallel corridor of double potentials during coronary sinus ( CS) pacing, ( 2) an activation detour by pacing either side of the line, and (3) differential pacing techniques. Isolation of all PVs and cavotricuspid isthmus ablation were performed successfully in all. Mitral isthmus block was achieved in 92 patients after 20+/-10 minutes of endocardial radiofrequency application and an additional 5+/-4 minutes of epicardial radiofrequency application from within the CS in 68, resulting in a conduction delay of 151+/-26 ms during CS pacing. Thirty-two patients with mitral isthmus ablation compared with 49 without had recurrent atrial arrhythmia (P=0.02) requiring further ablation. At 1 year after the last procedure, 87 patients with mitral isthmus ablation and 69 without (P=0.002) were arrhythmia free without antiarrhythmic drugs, mitral isthmus ablation being the only factor associated with long-term success (RR for AF recurrence, 0.2; CI, 0.1 to 0.4; P