Electrophysiologic and clinical consequences of linear catheter ablation to transect the anterior left atrium in patients with atrial fibrillation
Electrophysiologic and clinical consequences of linear catheter ablation to transect the anterior left atrium in patients with atrial fibrillation
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DOI：
10.1016/j.hrthm.2004.03.072
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发表时间：
2004-07-01
期刊：
影响因子：
5.5
通讯作者：
Haïssaguerre, M
中科院分区：
文献类型：
--
作者：
Sanders, P;Jaïs, P;Haïssaguerre, M
目的评价房颤（AF）患者左心房前壁横断消融术的可行性和疗效。背景虽然迷宫术能有效维持房颤患者的窦性心律，但其并发症严重。这项前瞻性临床研究评估了有限的LA线性消融的可行性和后果，横断前LA的AF患者。方法24例（51.2 +/- 7.3岁）阵发性（n = 16）或慢性（n = 8）AF耐肺静脉（PV）隔离进行了研究。为了横断左心房前部，进行线性消融，连接上级肺静脉;然后将这条线连接到二尖瓣前环。所有病例均行肺静脉电隔离和三尖瓣环峡部消融术。使用灌注导管进行消融，达到完全线性块的终点证明了在线双电位，差分起搏技术，和激活detour. Results的20例AF线性消融前，心律失常终止12（60%），包括一半的慢性AF患者，在消融过程中。尽管反复消融，24例患者中仅14例（58%）实现了完全线性阻滞。完全线性传导阻滞导致二尖瓣环和肺静脉周围的激活迂回，延迟158 30 ms（P = .0001），显著延迟激活的外侧LA与P波持续时间延长（P = .002），和特征性变化的P波形态在窦性心律（P = .002）。在14例左心房前壁横断患者中，4例（29%）由于通过恢复间隙的大折返而出现规则性房性心动过速。9这14个（64%）保持无血栓无抗血栓药相比，3 10（30%）不完全阻滞在28 - 4个月后，他们的最后一个程序（P = .2）。结论这项研究表明，导管消融的可行性，横断前LA在人类。虽然在终止AF方面是有效的，但这种线性损伤的配置在技术上具有挑战性，导致显著延迟的LA激活，并与适度的长期心律失常抑制相关。(C)2004心脏节律学会。All rights reserved.
OBJECTIVES To evaluate the feasibility and outcome of ablation to transect the anterior left atrium (LA) in patients with atrial fibrillation (AF).BACKGROUND While the Maze procedure is effective in maintaining sinus rhythm inpatients with AF, it is associated with significant morbidity. This prospective clinical study evaluates the feasibility and consequences of limited LA linear ablation to transect the anterior LA in patients with AF.METHODS Twenty-four patients (51.2 +/- 7.3 years) with paroxysmal (n = 16) or chronic (n = 8) AF resistant to pulmonary vein (PV) isolation were studied. To transect the anterior LA, linear ablation was performed joining the superior PVs; this line was then connected to the anterior mitral annulus. Pulmonary vein isolation and cavotricuspid isthmus ablation were performed in all cases. Ablation was performed using an irrigated catheter with the endpoint of achieving complete linear block demonstrated by online double potentials, differential pacing techniques, and an activation detour.RESULTS Of 20 patients in AF prior to linear ablation, arrhythmia terminated in 12 (60%), including half the patients with chronic AF, during ablation. Despite repeated ablation, complete linear block was achieved in only 14 of 24 patients (58%). Complete linear conduction block resulted in an activation detour around the mitral annulus and PVs with a delay of 158 30 ms (P = .0001), significantly delayed activation of the lateral LA with prolongation of P-wave duration (P = .002), and characteristic change in P-wave morphology during sinus rhythm (P = .002). Of the 14 with anterior LA transection, 4 (29%) have had regular atrial tachycardias due to macroreentry through recovered gaps. Nine of these 14 (64%) have remained arrhythmia-free without antiarrhythmics compared to 3 of 10 (30%) with incomplete block at 28 4 months following their last procedure (P = .2).CONCLUSIONS This study demonstrates the feasibility of catheter ablation to transect the anterior LA in humans. While being effective in the termination of AF, this configuration of linear lesions is technically challenging to complete, results in significant delayed LA activation, and is associated with modest long-term arrhythmia suppression. (C) 2004 Heart Rhythm Society. All rights reserved.