Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins -: Lessons from double lasso technique
Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins -: Lessons from double lasso technique
复制标题
DOI：
10.1161/01.cir.0000151289.73085.36
复制
发表时间：
2005-01-18
期刊：
影响因子：
37.8
通讯作者：
Kuck, KH
中科院分区：
文献类型：
--
作者：
Ouyang, FF;Antz, M;Kuck, KH
背景-房颤（AF）患者在同侧肺静脉（PV）周围连续环形病变（CCL）后，房性快速性心律失常（ATa）可复发。这项研究的特点，电生理结果在患者与无房性心动过速后，完全PV isolation.Methods和结果-二十九个100例患者复发房性心动过速后，完全PV隔离使用的CCLs在平均随访约8个月。在CCL后3至4个月，对26例ATa患者和7例无ATa的志愿者进行了重复手术。7名志愿者的肺静脉传导未恢复，而21名复发性房性心动过速患者的肺静脉传导恢复（9名患者的右侧肺静脉和16名患者的左侧肺静脉）。右侧肺静脉P波起始至最早肺静脉峰电位的间期为157 +/- 66 ms，左侧肺静脉为149 +/- 45 ms。在手术过程中，10例患者的PV心动过速激活心房并导致房性心动过速（AT）。所有传导间隙均通过节段性射频消融成功闭合。肺静脉电隔离后，3例患者诱发并消融了大折返性房速。在5例无肺静脉传导的患者中，2例左房顶部的局灶性AT和1例左房非肺静脉病灶成功消融;其余2例患者因不可诱导的心律失常而未进行消融。在平均约6个月的随访期间，24名患者在没有抗心律失常药物的情况下没有出现房性心动过速。结论-在CCL后复发的房性心动过速患者中，肺静脉传导恢复是大约80%患者的主要发现，并且可以通过节段性射频消融成功消除。此外，非肺静脉心律失常的标测和消融可提高临床成功率。
Background - Atrial tachyarrhythmias (ATa) can recur after continuous circular lesions (CCLs) around the ipsilateral pulmonary veins (PVs) in patients with atrial fibrillation (AF). This study characterizes the electrophysiological findings in patients with and without ATa after complete PV isolation.Methods and Results - Twenty-nine of 100 patients had recurrent ATa after complete PV isolation by use of CCLs during a mean follow-up of approximate to 8 months. A repeat procedure was performed in 26 patients with ATa and in 7 volunteers without ATa at 3 to 4 months after CCLs. No recovered PV conduction was demonstrated in the 7 volunteers, whereas recovered PV conduction was found in 21 patients with recurrent ATa (right-sided PVs in 9 patients and left-sided PVs in 16 patients). The interval from the onset of the P wave to the earliest PV spike was 157 +/- 66 ms in the right-sided PVs and 149 +/- 45 ms in the left-sided PVs. During the procedure, PV tachycardia activated the atrium and resulted in atrial tachycardia ( AT) in 10 patients. All conduction gaps were successfully closed with segmental RF ablation. After PV isolation, macroreentrant AT was induced and ablated in 3 patients. In the 5 patients without PV conduction, focal AT in the left atrial roof in 2 patients and non-PV foci in the left atrium in 1 patient were successfully abolished; in the remaining 2 patients, no ablation was performed because of noninducible arrhythmias. During a mean follow- up of approximate to6 months, 24 patients were free of ATa without antiarrhythmic drugs.Conclusions - In patients with recurrent ATa after CCLs, recovered PV conduction is a dominant finding in approximate to80% of patients and can be successfully eliminated by segmental RF ablation. Also, mapping and ablation of non-PV arrhythmias can improve clinical success.