Anatomical proximity between ganglionated plexi and epicardial adipose tissue in the left atrium: implication for 3D reconstructed epicardial adipose tissue-based ablation
Anatomical proximity between ganglionated plexi and epicardial adipose tissue in the left atrium: implication for 3D reconstructed epicardial adipose tissue-based ablation
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DOI：
10.1007/s10840-016-0130-9
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发表时间：
2016-11-01
影响因子：
1.8
通讯作者：
Hirayama, Atsushi
中科院分区：
文献类型：
--
作者：
Takahashi, Keiko;Okumura, Yasuo;Hirayama, Atsushi
为了更好地了解左心房(LA)的神经节丛(GP)、心外膜脂肪组织(EAT)与房颤(房颤)的发生和维持之间的关系和临床意义，对25例阵发性房颤(PAF)和15例持续性房颤(PerAF)患者的LA、PVs和LA-EAT的三维CT重建图像进行了合并。高频刺激(20 Hz，25 mA，10ms)在左上、左下、右前、右下和马歇尔束5个主要解剖部位各3个部位进行，以诱发迷走神经反应。检查五个GP区与迷走神经反应部位、LA-EAT和复杂的分心房电(CFAE)之间的对应关系。对31例PAF和102例PerAF患者进行了基于LA-EAT辅助消融的远期疗效评估，LA-EAT与5个主要解剖GP区的93+/-14%重叠，迷走神经反应部位和CFAE部位分别对应77+/-23和76+/-25%(P<；0.05)。基于EAT的消融消除了97.6%的迷走神经反应部位，并将房颤周期从160ms+/-26ms延长到193ms+/-27ms(p<；0.001)。房颤组和房颤组消融后2年无心律失常发生率分别为72%和73%(p=0.614)。LA-EAT倾向于覆盖主要的解剖GP区，包括与房颤相关的大部分活跃的GP反应部位和CFAE。消融GP和CFAE可以解释广泛环肺静脉隔离术(EEPVI)治疗房颤后基于EAT消融的长期疗效。
We sought to better understand the association between and clinical implications of ganglionated plexi (GPs), epicardial adipose tissue (EAT) in the left atrium (LA), and the initiation and maintenance of atrial fibrillation (AF).Three-dimensional (3D) computed tomography (CT) reconstruction images of the LA, PVs, and LA-EAT were merged with the LA geometry for 25 with paroxysmal AF (PAF) and 15 with persistent AF (PerAF) scheduled for ablation. High-frequency stimulation (20 Hz, 25 mA, 10 ms) was performed at three sites within each of the five major anatomical LA GPs (superior left, inferior left, anterior right, inferior right, and Marshall tract GPs) to elicit vagal responses. Correspondence between the five GP areas and vagal response sites, LA-EAT, and complex fractionated atrial electrograms (CFAEs) was examined. The long-term outcomes of adjuvant LA-EAT-based ablation were assessed in 31 patients with PAF and 102 with PerAF.LA-EAT overlapped 93 +/- 14 % of five major anatomical GP areas, and the vagal response sites and CFAE sites corresponded to 77 +/- 23 and 76 +/- 25 %, respectively (p < 0.05 for both vs. LA-EAT locations). The EAT-based ablation eliminated 97.6 % of the vagal response sites and lengthened the AF cycle from 160 +/- 26 to 193 +/- 27 ms (p < 0.001). The 2-year arrhythmia-free rate after EAT-based ablation was 72 % in the PAF group and 73 % in the PerAF group (p = 0.614).LA-EAT tends to overlie the major anatomical GP areas including most of the active GP response sites and CFAEs associated with AF. Ablation of GPs and CFAEs may explain the long-term efficacy of EAT-based ablation following extensive encircling pulmonary vein isolation (EEPVI) for AF.