Catheter ablation for paroxysmal atrial fibrillation - Segmental pulmonary vein ostial ablation versus left atrial ablation
Catheter ablation for paroxysmal atrial fibrillation - Segmental pulmonary vein ostial ablation versus left atrial ablation
复制标题
DOI：
10.1161/01.cir.0000095796.45180.88
复制
发表时间：
2003-11-11
期刊：
影响因子：
37.8
通讯作者：
Morady, F
中科院分区：
文献类型：
--
作者：
Oral, H;Scharf, C;Morady, F
背景：节段性心房导管消融（SOCA）分离肺静脉（pv）和左心房导管消融（LACA）包围pv都可以消除阵发性心房颤动（PAF）。这两种技术的相对疗效尚未被直接比较。方法与结果：连续80例有症状的PAF患者（年龄52+/-10岁），其中40例采用SOCA隔离PV， 40例采用LACA包围PV。在SOCA过程中，用环形导管记录的口腔PV电位是有针对性的。LACA在电解剖定位系统的引导下，将左侧和右侧pv环绕在离口1 ~ 2cm处；在二尖瓣峡部和左后心房也建立了消融线。SOCA的平均手术和透视时间分别为156+/-45分钟和50+/-17分钟，LACA的平均手术和透视时间分别为149+/-33分钟和39+/-12分钟。6个月时，67%的SOCA患者和88%的LACA患者在不服用抗心律失常药物治疗时无症状性PAF （P=0.02）。在年龄、性别、PAF持续时间和频率、射血分数、左房大小、结构性心脏病和消融技术等变量中，只有左房大小增大和SOCA技术是复发性PAF的独立预测因子。唯一的并发症是左心房扑动的病人接受了LACA。结论：在接受导管消融治疗PAF的患者中，LACA包围pv比SOCA更有效。
Background-Segmental ostial catheter ablation (SOCA) to isolate the pulmonary veins (PVs) and left atrial catheter ablation (LACA) to encircle the PVs both may eliminate paroxysmal atrial fibrillation (PAF). The relative efficacy of these 2 techniques has not been directly compared.Methods and Results-Of 80 consecutive patients with symptomatic PAF (age, 52+/-10 years), 40 patients underwent PV isolation by SOCA and 40 patients underwent LACA to encircle the PVs. During SOCA, ostial PV potentials recorded with a ring catheter were targeted. LACA was performed by encircling the left- and right-sided PVs 1 to 2 cm from the ostia and was guided by an electroanatomic mapping system; ablation lines also were created in the mitral isthmus and posterior left atrium. The mean procedure and fluoroscopy times were 156+/-45 and 50+/-17 minutes for SOCA and 149+/-33 and 39+/-12 minutes for LACA, respectively. At 6 months, 67% of patients who underwent SOCA and 88% of patients who underwent LACA were free of symptomatic PAF when not taking antiarrhythmic drug therapy (P=0.02). Among the variables of age, sex, duration and frequency of PAF, ejection fraction, left atrial size, structural heart disease, and the ablation technique, only an increased left atrial size and the SOCA technique were independent predictors of recurrent PAF. The only complication was left atrial flutter in a patient who underwent LACA.Conclusions-In patients undergoing catheter ablation for PAF, LACA to encircle the PVs is more effective than SOCA.