Clinical predictors and outcomes associated with acute return of pulmonary vein conduction during pulmonary vein isolation for treatment of atrial fibrillation
Clinical predictors and outcomes associated with acute return of pulmonary vein conduction during pulmonary vein isolation for treatment of atrial fibrillation
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DOI：
10.1016/j.hrthm.2006.05.007
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发表时间：
2006-09-01
期刊：
影响因子：
5.5
通讯作者：
Marchlinski, Francis E.
中科院分区：
文献类型：
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作者：
Sauer, William H.;McKernan, Melissa L.;Marchlinski, Francis E.
背景技术肺静脉电隔离（PVI）是治疗心房颤动（AF）的有效方法。然而，消融后肺静脉 (PV) 传导的复发可能会限制长期成功。 目的 我们试图确定 PVI 期间急性 PV 重新连接的临床预测因子，并评估与此现象相关的长期临床结果。 方法 我们研究了 2000 年 11 月至 2004 年 8 月期间转诊至 PVI 的所有 AF 患者。在研究期间，使用 4 毫米尖端（52度，40 W，最长 90 秒）或 8 毫米尖端导管（500、70 W，最长 60 秒）。 PVI 被定义为使用多极 Lasso 导管的入口和出口阻断。 20-60 分钟后，对所有静脉重新取样以确认隔离。房颤控制被定义为使用或停用先前无效的抗心律失常药物后未出现房颤。随访数据包括电话监测和从患者访谈中收集的临床数据。 结果 在研究期间，有 424 名患者接受了 1,347 个 PV 的隔离。 424 名患者中有 211 名 (50%) 发生了至少一处 PV 的急性重新连接，而 1,347 名目标 PV 中则有 326 名 (24%) 发生了急性重新连接。与其他静脉相比，左上静脉最有可能迅速恢复传导（左上静脉 31%，右上静脉 26%，右下静脉 22%，左下静脉 24%；P = .03）。急性重联患者更有可能年龄较大，左心房较大，有高血压或阻塞性陡峭呼吸暂停病史，并表现出持续性房颤。单次手术后，213 名出现急性 PV 重新连接的患者中有 153 名 (70%) 实现了 AF 控制，而未观察到急性 PV 重新连接的 211 名患者中有 148 名 (73%) 获得了 AF 控制 (P = .52)。结论 PV 传导急性恢复在成功 PVI 后很常见，并且更可能发生在患有非阵发性 AF、高血压、左心房大和陡峭的老年患者中。呼吸暂停。尽管能量输送的功率和持续时间存在差异，但 4 毫米和 8 毫米尖端射频导管之间的急性 PV 重新连接没有显着差异。此外，反复断开后，PV重新连接对长期AF控制没有影响。
BACKGROUND Pulmonary vein electrical isolation (PVI) is an effective treatment for atrial fibrillation (AF). However, recurrence of pulmonary vein (PV) conduction after ablation may limit Longterm success.OBJECTIVE We sought to determine the clinical predictors of acute PV reconnection during PVI and assess the Long-term clinical outcomes associated with this phenomenon.METHODS We studied all patients with AF referred for PVI between November 2000 and August 2004. Over the course of the study period, PVI of arrhythmogenic PVs was performed segmentally using a 4-mm tip (52 degrees, 40 W, up to 90 seconds) or 8-mm tip catheter (500, 70 W, up to 60 seconds). PVI was defined as entry and exit block using a multipolar Lasso catheter. ALL veins were resampled to confirm isolation after 20-60 minutes. AF control was defined as no AF on or off a previously ineffective antiarrhythmic drug. Follow-up data included transtelephonic monitoring and clinical data collection from patient interviews.RESULTS There were 424 patients who underwent isolation of 1,347 PVs during the study period. Acute reconnection of at least one PV occurred in 211 (50%) of the 424 patients and 326 (24%) of 1,347 of the PVs targeted. The left superior PV was most likely to acutely recover conduction compared with the other veins (Left superior 31%, right superior 26%, right inferior 22%, left inferior 24%; P = .03). Patients with acute reconnection were more Likely to be older, have a Larger Left atrium, have a history of hypertension or obstructive steep apnea, and demonstrate persistent AF. After a single procedure, AF control was achieved in 153 (70%) of the 213 patients who demonstrated acute PV reconnection compared with 148 (73%) of 211 patients without acute PV reconnection observed (P = .52).CONCLUSIONS Acute return of PV conduction is common after successful PVI and is more Likely to occur in older patients with nonparoxysmal AF, hypertension, a large left atrium, and steep apnea. There was no significant difference in acute PV reconnection between the 4-mm and 8-mm tip RF catheter despite differences in power and duration of energy delivery. Furthermore, there was no effect of PV reconnection on long-term AF control after repeated disconnection was performed.