Predictors of recurrence of atrial tachyarrhythmias after pulmonary vein isolation by functional and structural mapping of nonparoxysmal atrial fibrillation.
Predictors of recurrence of atrial tachyarrhythmias after pulmonary vein isolation by functional and structural mapping of nonparoxysmal atrial fibrillation.
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DOI：
10.1002/joa3.12670
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发表时间：
2022-03
影响因子：
2
通讯作者：
Komaru T
中科院分区：
文献类型：
--
作者：
Kumagai K;Sato T;Kurose Y;Sumiyoshi T;Hasegawa K;Sekiguchi Y;Yambe M;Komaru T
本研究旨在评估非阵发性心房颤动（AF）患者在肺静脉隔离（PVI）后，通过结构和功能定位：电压、主导频率（DF）和转子定位来预测房性心动过速复发。对66例非阵发性房颤患者进行前瞻性研究。在PVI后，利用在线实时相位映射系统检测左房各节段临界非被动激活比(%NPs)≧50%的转子位置，并同时绘制≧7 Hz的高DFs。恢复窦性心律后，使用Advisor HD网格导管（HDG）绘制低电压区（lva < 0.5 mV）。66例AF患者中有64例（97%）存在最小至轻度LVAs，无论LAD和LA体积是否增大（45±6.0 mm和141±29 ml）。复发性房性心动过速与非复发性房性心动过速的最大DF值、平均DF值和%NPs值差异无统计学意义。然而，复发性房性心动过速患者与非复发性房性心动过速患者的LVA/LA表面积有显著差异（p = 0.004）。在11.6±0.8个月的随访中，lva≤3.3%的患者的房性心动过速自由度明显高于lva≤3.3%的患者（77.1% vs. 33.3%, p < 0.001）。在多变量分析中，PVI后LVA/LA表面积（HR 1.079; CI 1.025-1.135, p = 0.003）是AF复发的独立预测因子。在非阵发性房颤患者中，PVI后房性心动过速复发的预测因子是lva而不是DFs和转子。lva是PVI后房颤/AT复发的独立预测因子。HDG可能会排除假lva，这将有助于更准确地检测AF底物。非阵发性房颤合并心房重构患者经PVI后，HDG准确检测到的lva可能比单独的DFs和旋转体更具选择性。
This study aimed to evaluate the predictors of recurrence of atrial tachyarrhythmias by structural and functional mapping: voltage, dominant frequency (DF), and rotor mapping after a pulmonary vein isolation (PVI) in nonparoxysmal atrial fibrillation (AF) patients. A total of 66 nonparoxysmal AF patients were prospectively investigated. After the PVI, an online real‐time phase mapping system was used to detect the location of rotors with critical nonpassively activated ratios (%NPs) of ≧50% in each left atrial (LA) segment, and high‐DFs of ≧7 Hz were simultaneously mapped. After restoring sinus rhythm, low‐voltage areas (LVAs < 0.5 mV) were mapped using the Advisor HD grid catheter (HDG). Sixty‐four of 66 (97%) AF patients had minimum to mild LVAs regardless of an enlarged LAD and LA volume (45 ± 6.0 mm and 141 ± 29 ml). There were no significant differences in the max and mean DF values and %NPs between the patients with and without recurrent atrial tachyarrhythmias. However, there was a significant difference in the LVA/LA surface area between the patients with and without recurrent atrial tachyarrhythmias (p = .004). Atrial tachyarrhythmia freedom was significantly greater in those with LVAs of ≤3.3% than in those >3.3% after one procedure over 11.6 ± 0.8 months of follow‐up (77.1% vs. 33.3%, p < .001). In a multivariate analysis, the LVA/LA surface area after the PVI (HR 1.079; CI, 1.025–1.135, p = .003) was an independent predictor of AF recurrence. The predictor of atrial tachyarrhythmia recurrence after the PVI was LVAs rather than DFs and rotors in nonparoxysmal AF patients. The LVAs were an independent predictor of recurrent AF/AT after the PVI. The HDG might exclude false LVAs, which would help detect the AF substrate more accurately. LVAs detected accurately by the HDG might be more selective targets than DFs and rotors alone after the PVI in nonparoxysmal AF patients with atrial remodeling.
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DOI：
10.1111/j.1540-8167.2012.02332.x
发表时间：
2012-05-01
影响因子：
2.7
作者：
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影响因子：
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