Effect of ablation at high-dominant frequency sites overlapping with low-voltage areas after pulmonary vein isolation of nonparoxysmal atrial fibrillation
Effect of ablation at high-dominant frequency sites overlapping with low-voltage areas after pulmonary vein isolation of nonparoxysmal atrial fibrillation
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DOI：
10.1111/jce.14090
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发表时间：
2019-08-06
影响因子：
2.7
通讯作者：
Komaru, Tatsuya
中科院分区：
文献类型：
--
作者：
Kumagai, Koji;Minami, Kentaro;Komaru, Tatsuya
背景：非阵发性房颤（AF）患者高主频（DF）部位与低电压区（LVAs）之间的关系仍不清楚。目的评价肺静脉消融（PVI）治疗非阵发性房颤（房颤）后，对高DF部位与左室重叠部位的消融效果。方法回顾性分析128例非阵发性房颤患者（53例持续性房颤）的临床资料。房颤患者分为两组：单纯环周肺静脉隔离（PVI组，n = 57）和肺静脉隔离后进行DF消融（DF组，n = 71）。结果两组患者的特征无显著性差异。然而，DF组的LVA（< 0.5 mV）/左心房（LA）表面显著大于PVI组（22% vs 16%，P = 0.02）。DF组中与LA中的LVA重叠的总最大DF部位显著高于PVI组（91% vs 10%，P = 0.001）。在10.0 +/- 3.2个月的随访期间，DF组抗心律失常药物的无房性心律失常率显著高于PVI组（83.1% vs 64.9%，对数秩检验P = 0.021）。PVI组的无事件生存率根据LVA程度而降低，而DF组的无事件生存率> 80%。DF组AF患者，尤其是广泛LVA患者（>= 30%）的无事件生存率显著高于PVI组（81.0% vs 45.5%，对数秩检验P = 0.035）。结论肺静脉隔离后与左室动脉重叠的高DF部位可能是非阵发性房颤患者心房基质改良的潜在选择性靶点。
Background The relationship between high-dominant frequency (DF) sites and low-voltage areas (LVAs) in nonparoxysmal atrial fibrillation (AF) patients still remains unknown. Objective This study aimed to evaluate the effect of ablation at high-DF sites overlapping with LVAs after pulmonary vein ablation (PVI) of nonparoxysmal AF. Methods A total of 128 consecutive nonparoxysmal patients with atrial fibrillation (53 persistent AF) were retrospectively investigated. The patients with AF were divided into two groups: patients with circumferential PVI alone (PVI group, n = 57) and those with PVI followed by a DF-based ablation (DF group, n = 71). Results The patient characteristics did not significantly differ between the two groups. However, the LVA ( < 0.5 mV)/left atrial (LA) surface was significantly greater in the DF than the PVI group (22% vs 16%, P = .02). The total max-DF sites overlapping with LVAs in the LA were significantly greater in the DF than the PVI group (91% vs 10%, P = .001). The atrial arrhythmia freedom on antiarrhythmic drugs in the DF group was significantly greater than that in the PVI group during 10.0 +/- 3.2 months of follow-up (83.1% vs 64.9%, log-rank test P = .021). The event-free survival in the PVI group decreased according to the LVA extent while it was > 80% in the DF group. The event-free survival in patients with AF especially with extensive LVAs ( >= 30%) in the DF group was significantly greater than that in the PVI group (81.0% vs 45.5%, log-rank test P = .035). Conclusions High-DF sites overlapping with LVAs after the PVI may be potential selective targets for modification of atrial substrates in nonparoxysmal AF patients.