Disparate evolution of right and left atrial rate during ablation of long-lasting persistent atrial fibrillation.
Disparate evolution of right and left atrial rate during ablation of long-lasting persistent atrial fibrillation.
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DOI：
10.1016/j.jacc.2009.09.060
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发表时间：
2010-03-09
影响因子：
24
通讯作者：
Haissaguerre, Michel
中科院分区：
文献类型：
--
作者：
Hocini, Meleze;Nault, Isabelle;Wright, Matthew;Veenhuyzen, George;Narayan, Sanjiv M.;Jais, Pierre;Lim, Kang-Teng;Knecht, Sebastien;Matsuo, Seiichiro;Forclaz, Andrei;Miyazaki, Shinsuke;Jadidi, Amir;O'Neill, Mark D.;Sacher, Frederic;Clementy, Jacques;Haissaguerre, Michel
评估右心房（RA）额外消融是否可提高长期持续性房颤（PsAF）的终止率。从左心耳测量的房颤（AF）周期长度（CL）延长预测PsAF导管消融期间的良好结局。然而，在一些患者中，尽管消融术延长了左心房（LA）的AFCL，但AF仍然存在。我们假设这是由于RA驱动因素，这些患者可能从RA消融中受益。研究了148例接受PsAF导管消融术（持续时间25±32个月）的连续患者。从左心房开始逐步消融期间，监测两个心房的AFCL。当AF中的所有LA源均已消融且存在RA-LA梯度时，在RA中进行消融。手术终点为房颤终止。在左心房消融术期间出现了两种不同的AFCL变化模式。在104例患者（70%）中，左心房和右心房的AFCL平行增加，在房颤终止时达到峰值（基线：左心房153 ms [140，170]，右心房155 ms [143，171];消融后：左心房181 ms [170，200]，右心房186 ms [175，202]）。在24例患者（19%）中，RA AFCL没有延长，产生了从右到左的频率梯度（基线：LA 142 ms [143，153]，RA 145 ms[139，162];消融后：LA 177 ms[165-185]，RA 152 ms [147，175]）。这些患者的房颤病史较长（23个月vs 12个月，p=0.001），右心房直径较大（42 mm vs 39 mm，p=0.005），右心房消融终止房颤的比例为55%。在其余20例患者中，双房消融未能终止AF。LA消融后AFCL延长的发散模式导致右向左梯度，表明右心房在约20%的PsAF中驱动AF。
To assess whether additional ablation in the right atrium(RA) improves termination rate in long-lasting persistent atrial fibrillation(PsAF). Prolongation of atrial fibrillation(AF) cycle length(CL) measured from the left atrial appendage predicts favorable outcome during catheter ablation of PsAF. However, in some patients despite prolongation of AFCL in the left atrium(LA) with ablation, AF persists. We hypothesized that this is due to RA drivers and these patients may benefit from RA ablation. 148 consecutive patients undergoing catheter ablation of PsAF(duration 25±32 months) were studied. AFCL was monitored in both atria during stepwise ablation commencing in the LA. Ablation was performed in the RA when all LA sources in AF had been ablated and a RA-LA gradient existed. The procedural endpoint was AF termination. Two distinct patterns of AFCL change emerged during LA ablation. In 104patients(70%), there was parallel increase of AFCL in LA and RA culminating in AF termination (baseline: LA 153ms[140,170], RA 155ms[143,171]; after ablation: LA 181ms[170,200], RA 186ms[175,202]). In 24 patients(19%), RA AFCL did not prolong, creating a right-to-left frequency gradient, (baseline: LA 142ms[143,153], RA 145 ms[139,162]; after ablation: LA 177 ms[165–185], RA 152ms[147,175]). These patients had a longer AF history (23versus12 months, p=0.001), and larger RA diameter (42versus39mm, p=0.005) and RA ablation terminated AF in 55%. In the remaining 20 patients, biatrial ablation failed to terminate AF. A divergent pattern of AFCL prolongation after LA ablation resulting in a right-to-left gradient demonstrating that the right atrium is driving AF in about 20 % of PsAF.
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影响因子：
37.8
作者：
Haïssaguerre, M;Sanders, P;Jaïs, P
通讯作者：
Jaïs, P
DOI：
10.1007/s10840-005-2492-2
发表时间：
2005-08-01
影响因子：
1.8
作者：
Scherlag, BJ;Nakagawa, H;Lazzara, R
通讯作者：
Lazzara, R
DOI：
10.1046/j.1460-9592.2002.00342.x
发表时间：
2002-03-01
影响因子：
1.8
作者：
Ho, SY;Anderson, RH;Sánchez-Quintana, D
通讯作者：
Sánchez-Quintana, D
DOI：
10.1111/j.1540-8167.2007.00930.x
发表时间：
2007-10-01
影响因子：
2.7
作者：
Schmitt, Claus;Estner, Heidi;Deisenhofer, Isabel
通讯作者：
Deisenhofer, Isabel
影响因子：
37.8
作者：
Jaïs, P;Hocini, M;Haïssaguerre, M
通讯作者：
Haïssaguerre, M