Crucial role of pulmonary vein firing as an initiator of typical atrial flutter: Evidence of a close relationship between atrial fibrillation and typical atrial flutter.
Crucial role of pulmonary vein firing as an initiator of typical atrial flutter: Evidence of a close relationship between atrial fibrillation and typical atrial flutter.
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DOI：
10.1016/j.joa.2016.07.013
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发表时间：
2017-04
影响因子：
2
通讯作者：
Aonuma K
中科院分区：
文献类型：
--
作者：
Kaneshiro T;Yoshida K;Sekiguchi Y;Tada H;Kuroki K;Kuga K;Kamiyama Y;Suzuki H;Takeishi Y;Aonuma K
几项研究报告了三尖瓣环峡部依赖性房扑（典型AFL）经常与房颤（AF）并存;然而，其潜在机制尚未得到充分研究。本研究旨在揭示典型AFL的发生机制以及典型AFL与AF之间的关系。在154例首次接受AF导管消融术的连续患者中，我们研究了导管消融术中自发性发生典型AFL的表现和机制。然后，我们回顾性研究了67名连续患者，这些患者既往没有AF发作，接受了典型的AFL消融术。评估导管消融术后房颤的发生率和预测因素。在房颤消融期间，8例（5.2%）患者在窦性心律期间自发启动典型AFL。典型AFL的起始点为肺静脉（PV）击发，但1例患者除外，其阵发性AF伴上级腔静脉击发，在PV隔离后引发反向典型AFL。典型AFL消融后，23例（34.3%）患者发生AF（平均随访28.2±20.3个月）。Kaplan-Meier分析显示，左心房直径大于40 mm的患者在典型AFL消融后AF的发生率显著较高（对数秩检验，P=0.046）。肺静脉通过房颤放电在典型房扑的发生中起重要作用。典型AFL消融后房颤发生率高，左房扩大与房颤发生率增高相关，揭示了典型AFL与房颤，尤其是肺静脉放电的密切关系。
Several studies reported that cavotricuspid isthmus-dependent atrial flutter (typical AFL) frequently coexists with atrial fibrillation (AF); however, the underlying mechanisms have not been fully investigated. This study aimed to reveal the mechanisms of the initiation of typical AFL and the association between typical AFL and AF. Among 154 consecutive patients undergoing a first catheter ablation of AF, we investigated the appearance and mechanism of spontaneous initiation of typical AFL during catheter ablation. Then, we retrospectively investigated 67 consecutive patients without a previous AF episode who underwent typical AFL ablation. The occurrence and predictors of AF after catheter ablation were evaluated. During AF ablation, spontaneous initiation of typical AFL occurred during sinus rhythm in eight (5.2%) patients. The initiations of typical AFL were pulmonary vein (PV) firings except in one patient, in whom paroxysmal AF following superior vena cava firing initiated reverse typical AFL after PV isolation. After typical AFL ablation, AF occurred in 23 (34.3%) patients (mean follow up, 28.2±20.3 months). Kaplan-Meier analysis showed the occurrence of AF after typical AFL ablation to be significantly higher in the patients with a larger left atrial diameter over 40 mm (log-rank test, P=0.046). PV firing through AF played an important role in initiating typical AFL. The occurrence of AF after typical AFL ablation was high, and a dilated left atrium was associated with increased occurrence of AF. These findings disclosed the close relationship between typical AFL and AF, especially PV firing.