Radiofrequency catheter ablation of chronic atrial fibrillation guided by complex electrograms
Radiofrequency catheter ablation of chronic atrial fibrillation guided by complex electrograms
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DOI：
10.1161/circulationaha.107.691386
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发表时间：
2007-05-22
期刊：
影响因子：
37.8
通讯作者：
Morady, Fred
中科院分区：
文献类型：
--
作者：
Oral, Hakan;Chugh, Aman;Morady, Fred
背景-据报道，在复杂碎裂心房电图指导下进行房颤（AF）的射频导管消融可消除大部分患者的AF。然而，只有少数慢性房颤患者已纳入先前的研究。方法和结果-在100例患者（平均年龄，57 +/- 11岁）患有慢性AF，进行射频消融，以靶向肺静脉口和窦区、左心房的各个区域的复杂碎裂心房电图，和冠状窦，直到房颤终止或所有识别的复杂碎裂心房电图消除。46%的患者消融部位包括≥ 1条肺静脉;所有患者消融部位均为左房间隔、左房顶或左房前壁; 55%的患者消融部位为冠状窦。在单次消融术后14 +/- 7个月的随访期间，33%的患者在未使用抗心律失常药物的情况下处于窦性心律，38%的患者患有AF，17%的患者患有AF和房扑，9%的患者患有持续性房扑，3%的患者在使用抗心律失常药物的情况下患有阵发性AF。44%的患者进行了第二次消融术。所有患者在既往靶向和非靶向肺静脉中均发现肺静脉心动过速。心房扑动大多数患者存在多个大折返环。在最后一次消融术后13 +/- 7个月，57%的患者处于窦性心律，没有抗心律药物，32%的患者有持续性AF，6%的患者有阵发性AF，5%的患者有心房扑动。但仅在> 40%的患者中在第二次消融手术之后。肺静脉快速活动和多个大折返环是复发性房性心律失常的常见机制。
Background - Radiofrequency catheter ablation of atrial fibrillation (AF) guided by complex fractionated atrial electrograms has been reported to eliminate AF in a large proportion of patients. However, only a small number of patients with chronic AF have been included in previous studies.Methods and Results - In 100 patients (mean age, 57 +/- 11 years) with chronic AF, radiofrequency ablation was performed to target complex fractionated atrial electrograms at the pulmonary vein ostial and antral areas, various regions of the left atrium, and the coronary sinus until AF terminated or all identified complex fractionated atrial electrograms were eliminated. Ablation sites consisted of >= 1 pulmonary vein in 46% of patients; the left atrial septum, roof, or anterior wall in all; and the coronary sinus in 55%. During 14 +/- 7 months of follow-up after a single ablation procedure, 33% of patients were in sinus rhythm without antiarrhythmic drugs, 38% had AF, 17% had both AF and atrial flutter, 9% had persistent atrial flutter, and 3% had paroxysmal AF on antiarrhythmic drugs. A second ablation procedure was performed in 44% of patients. Pulmonary vein tachycardia was found in all patients in both previously targeted and nontargeted pulmonary veins. There were multiple macroreentrant circuits in the majority of patients with atrial flutter. At 13 +/- 7 months after the last ablation procedure, 57% of patients were in sinus rhythm without antiarrhythmic drugs, 32% had persistent AF, 6% had paroxysmal AF, and 5% had atrial flutter.Conclusions - Modest short- term efficacy is achievable with radiofrequency ablation of chronic AF guided by complex fractionated atrial electrograms, but only after a second ablation procedure in > 40% of patients. Rapid activity in the pulmonary veins and multiple macroreentrant circuits are common mechanisms of recurrent atrial arrhythmias.