Catheter Ablation of Atrial Fibrillation in Patients with Mechanical Mitral Valve: Long-Term Outcome of Single Procedure of Pulmonary Vein Antrum Isolation with or without Nonpulmonary Vein Trigger Ablation
Catheter Ablation of Atrial Fibrillation in Patients with Mechanical Mitral Valve: Long-Term Outcome of Single Procedure of Pulmonary Vein Antrum Isolation with or without Nonpulmonary Vein Trigger Ablation
复制标题
机械二尖瓣患者心房颤动的导管消融：肺静脉窦隔离单次手术联合或不联合非肺静脉触发消融的长期结果。
DOI：
10.1111/jce.12433
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发表时间：
2014-08-01
影响因子：
2.7
通讯作者：
Natale, Andrea
中科院分区：
文献类型：
--
作者：
Bai, Rong;Di Biase, Luigi;Natale, Andrea
MMV患者AF消融的长期结局。简介：目前尚不清楚在接受AF消融的机械二尖瓣（MMV）患者中，延长肺静脉窦隔离（PVAI）+非肺静脉（非PV）触发消除是否比单独PVAI更能预防心律失常复发。本研究比较了两种消融策略--单纯PVAI与扩大PVAI加非PV触发消除--治疗MMV患者AF的疗效和长期结局。方法和结果：109例连续的MMV AF患者分为2组：第1组（N = 45）进行标准PVAI;在第2组（N = 64）中，PVAI扩展至LA后壁、LA间隔和CS;所有非PV触发因素均被消除。随访3年。第12个月时，第1组7例（15.6%）和第2组39例（60.9%）患者无心律失常（对数秩P < 0.001）。第1组4例患者（8.9%; 3例AT和1例AF）和第2组12例患者（18.8%; 9例AT和3例AFL）出现极晚期复发。在36 +/- 7个月随访时，单次手术后的累积复发率为42/45第1组为93.3%，第6组为37/64第2组（57.8%）（对数秩P < 0.001）。与单独的标准PVAI相比，在接受AF消融的MMV患者中，包括延长PVAI和消除非PV触发因素的策略与更高的12个月和长期无房颤生存率相关。极晚期复发可能发生在初次手术后数年，局灶性房性心动过速是最常见的复发性心律失常类型。
Long-Term Outcome of AF Ablation in MMV Patients. Introduction: It is unclear whether extended pulmonary vein antrum isolation (PVAI) plus nonpulmonary vein (non-PV) trigger elimination prevents more arrhythmia recurrence than PVAI alone in patients with mechanical mitral valve (MMV) undergoing AF ablation. This study compared the efficacy and long-term outcome of 2 ablation strategies-PVAI alone versus extended PVAI plus non-PV trigger elimination-for the treatment of AF in patients with MMV.Methods and Results: One hundred and nine consecutive AF patients with MMV were divided into 2 groups: standard PVAI was performed in group 1 (N = 45); in group 2 (N = 64) PVAI was extended to the LA posterior wall, LA septum, and CS; and all non-PV triggers were eliminated. Patients were followed up for 3 years. At the 12th month, 7 (15.6%) patients in group 1, and 39 (60.9%) patients in group 2 were arrhythmia free (log-rank P < 0.001). Four patients (8.9%; 3 cases of AT and 1 case of AF) from group 1, and 12 patients (18.8%; 9 cases of AT, and 3 cases of AFL) from group 2 experienced very late recurrence. At 36 +/- 7 months follow-up, the cumulative recurrence after a single procedure was 42/45 (93.3%) in group 1, and 37/64 (57.8%) in group 2 (log-rank P < 0.001).Conclusion: Compared with the standard PVAI alone, a strategy including extended PVAI and non-PV trigger elimination is associated with a higher 12-month and long-term arrhythmia-free survival in patients with MMV undergoing AF ablation. Very late recurrence may occur years after the initial procedure with focal AT as the most common type of recurrent arrhythmia.