Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation
Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation
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DOI：
10.1093/europace/eul077
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发表时间：
2006-08-01
期刊：
影响因子：
6.1
通讯作者：
Schmitt, Claus
中科院分区：
文献类型：
--
作者：
Deisenhofer, Isabel;Estner, Heidi;Schmitt, Claus
目的探讨心房颤动（AF）患者行环肺静脉消融（CPVA）后左房（LA）心动过速的发生率、电生理特性和消融效果。方法和结果67例房颤患者行CPVA。在21/67（31%）患者和16/21有症状的患者中，发现了55例LA心动过速（每例3.4 +/- 2.4）：18例（33%）心动过速与二尖瓣周围大血管再入(7)或肺静脉（11）有关。在20例（36%）心动过速中，发现了“小环”LA再入性心动过速（LART）；先前消融线的间隙（7个LART）或靠近CPVA病变的传导极慢的区域（13个LART）对这些再入至关重要。17例（31%）心动过速过于不稳定，无法完成制图。消融在38例LART中有34例（89%）取得初步成功，但在21例手术中有8例需要复律以达到窦性心律。结论CPVA术后LART发生率高。可能会出现难以绘制的小循环再入，并且患者患有几种和/或不稳定的LART变体。因此，这些LART的定位和消融是具有挑战性的，总体上的成功尚不令人满意。
Aims To investigate the incidence, electrophysiological properties, and ablation results for left atrial (LA) tachycardia as a sequel to the circumferential pulmonary vein ablation (CPVA) for atrial, fibrillation (AF).Methods and results Sixty-seven patients with AF underwent CPVA. Sustained LA tachycardia developed in 21/67 (31%) patients and in 16/21 symptomatic patients 55 LA tachycardias (3.4 +/- 2.4 per patient) were mapped: 18 (33%) tachycardias were related to macro-re-entry around the mitral valve (7) or pulmonary vein(s) (11). In 20 tachycardias (36%), a 'small-loop' LA re-entrant tachycardia (LART) was identified; gaps in prior ablation lines (7 LART) or an area of extremely stow conduction adjacent to the CPVA lesions (13 LART) were crucial for these re-entries. Seventeen tachycardias (31%) were too unstable for complete mapping. Ablation was a primary success in 34 of 38 (89%) mapped LART, but in eight of 21 procedures, cardioversion was necessary to achieve sinus rhythm.Conclusion LART develops in a high percentage of patients after CPVA. Small-loop re-entry, which is difficult to map, may arise and patients suffer from several and/or unstable variants of LART. Thus, mapping and ablation of these LART is challenging and the overall success is yet not satisfactory.