Long-term results of pulmonary vein antrum isolation in patients with atrial fibrillation: an analysis in regards to substrates and pulmonary vein reconnections.
Long-term results of pulmonary vein antrum isolation in patients with atrial fibrillation: an analysis in regards to substrates and pulmonary vein reconnections.
复制标题
房颤患者肺静脉窦隔离的长期结果：关于基质和肺静脉重新连接的分析。
作者：
T. Yamaguchi;T. Tsuchiya;Y. Nagamoto;Koji Miyamoto;K. Murotani;K. Okishige;N. Takahashi
旨在
研究左心房（LA）低电压区（LVZ）对肺静脉窦隔离（PVAI）后房颤（AF）复发的影响，但不改变LA底物。
方法和结果
前瞻性入组了76例AF患者（阵发性/持续性65/11）。使用NavX在窦性心律期间构建左心房电压标测图，以识别LVZ（<0.5 mV），并使用开放式灌注导管进行无任何LA底物修饰的PVAI。PVAI后，注射20 mg三磷酸腺苷（ATP）。三磷酸腺苷诱导的肺静脉重连在揭盲后通过修补消融消除。电压图显示24例患者（32%）有LVZ，52例患者（68%）无LVZ。在24 ± 7个月的随访中，15名LVZ患者（63%）和10名无AF患者（19%）在停用抗心律失常药物后复发（对数秩P < 0.001）。多因素Logistic回归分析显示LVZ面积[比值比（OR）：1.12/1cm（2），95%可信区间（CI）：1.04-1.23，P = 0.001]和ATP诱导的再连接（OR：2.08，95%CI：1.01-4.91，P = 0.046）是复发的显著预测因素。在LVZ患者中，LVZ面积与LA体积密切相关（r = 0.81，P < 0.001），是复发的唯一预测因子（OR：1.17/1cm（2），95% CI：1.01-1.55，P = 0.031），而在无LVZ的患者中，ATP诱导的PV重新连接是唯一的预测因素（OR：3.24，95%CI：1.15-15.39，P = 0.025）。
结论
LVZ面积是无任何LA底物修饰的PVAI后复发的独立预测因子。三磷酸腺苷诱导的肺静脉再连接也是一个独立的预测因子，特别是在那些没有LVZ的患者中。
AIMS
To examine the impact of left atrial (LA) low-voltage zones (LVZs) on atrial fibrillation (AF) recurrence after pulmonary vein antrum isolation (PVAI) without LA substrate modification.
METHODS AND RESULTS
Seventy-six patients with AF (paroxysmal/persistent 65/11) were prospectively enroled. Left atrial voltage maps were constructed during sinus rhythm using NavX to identify LVZs (<0.5 mV), and PVAI without any LA substrate modification was performed using an open-irrigation catheter. After PVAI, 20 mg of adenosine triphosphate (ATP) was injected. Adenosine triphosphate-induced PV reconnections were eliminated by touch-up ablation when unmasked. Voltage maps revealed LVZs in 24 patients (32%) and no LVZs in 52 (68%). During 24 ± 7 months of follow-up, 15 patients (63%) with LVZs and 10 (19%) without had AF recurrences off antiarrhythmic drugs (log-rank P < 0.001). A multivariate logistic regression analysis revealed that LVZ areas [odds ratio (OR): 1.12 per 1 cm(2), 95% confidence interval (CI): 1.04-1.23, P = 0.001] and ATP-induced reconnection (OR: 2.08, 95% CI: 1.01-4.91, P = 0.046) were significant predictors of recurrence. In those with LVZs, the LVZ area was strongly correlated with the LA body volume (r = 0.81, P < 0.001) and a unique predictor of recurrence (OR: 1.17 per 1 cm(2), 95% CI: 1.01-1.55, P = 0.031), while in those without an LVZ, ATP-induced PV reconnection was a unique predictor (OR: 3.24, 95% CI: 1.15-15.39, P = 0.025).
CONCLUSION
The LVZ area was an independent predictor of recurrence after PVAI without any LA substrate modification. Adenosine triphosphate-induced PV reconnection was also an independent predictor, especially in those without LVZs.
影响因子：
5.5
作者：
Mahnkopf, Christian;Badger, Troy J.;Burgon, Nathan S.;Daccarett, Marcos;Haslam, Thomas S.;Badger, Christopher T.;McGann, Christopher J.;Akoum, Nazem;Kholmovski, Eugene;Macleod, Rob S.;Marrouche, Nassir F.
通讯作者：
Marrouche, Nassir F.