Extensive right atrial free wall low-voltage zone as the substrate for atrial fibrillation: successful ablation by scar homogenization
Extensive right atrial free wall low-voltage zone as the substrate for atrial fibrillation: successful ablation by scar homogenization
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DOI：
10.1093/europace/euaa233
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发表时间：
2021-01-01
期刊：
影响因子：
6.1
通讯作者：
Kalman, Jonathan M.
中科院分区：
文献类型：
--
作者：
Al-Kaisey, Ahmed M.;Parameswaran, Ramanathan;Kalman, Jonathan M.
目的：先前的研究已经描述了起源于右心房（RA）的房颤（AF）的各种机制。在这项研究中，我们报告了一系列的患者中，广泛的右心房游离壁低电压区（LVZ）担任AF substrate.Methods和结果5例临床综合征的阵发性AF和房性心动过速（AT）进行电生理评价。5例患者（3例男性;年龄52 ± 7岁）有症状性阵发性AF（28 ± 17个月），对药物治疗无反应。在初始EP研究中，4例患者的AT是诱导性的，1例患者是自发性的。在所有患者中，心动过速不稳定排除了详细的AT标测。窦或起搏图显示RA外侧小梁化游离壁中广泛的LVZ，其由散布在电静默区之间的低振幅复合信号区域组成。旨在使LVZ电惰性的射频消融成功消除了5例患者中的4例AF。在28 +/- 15个月的随访，1例患者有孤立的复发AF。然而，2例患者需要重复消融复发AT。结论广泛的LVZ的小梁RA游离壁构成了一个不寻常的基板AF。这些患者也表现出不稳定的AT起源于同一区域。射频消融使低电压区电惰性是管理AF和AT的有效策略。
Aims Prior studies have described a variety of mechanisms for atrial fibrillation (AF) originating in the right atrium (RA). In this study, we report a series of patients in whom an extensive right atrial free wall low-voltage zone (LVZ) served as the AF substrate.Methods and results Five patients with a clinical syndrome of paroxysmal AF and atrial tachycardia (AT) underwent electrophysiologic evaluation. Five patients (3 M; age 52 +/- 7 years) had symptomatic paroxysmal AF for (28 +/- 17 months) not responsive to medical therapy. At the initial EP study, AT was inducible in four patients and was spontaneous in one patient. In all patients, tachycardia instability precluded detailed AT mapping. Sinus or pace maps indicated an extensive LVZ in the lateral RA trabeculated free wall which consisted of regions of low amplitude complex signals interspersed between electrically silent areas. Radiofrequency ablation aimed at rendering the LVZ electrical inert was successful in eliminating AF in four of five patients. At a follow-up of 28 +/- 15 months, one patient had an isolated recurrence of AF. However, two patients required repeat ablation for recurrent AT.Conclusion An extensive LVZ in the trabeculated RA free wall constitutes an unusual substrate for AF. These patients also demonstrate unstable ATs originating from the same zone. Radiofrequency ablation to render the low-voltage zone electrically inert is an effective strategy to manage AF and AT.