Difference in the Maintenance Mechanism of Atrial Fibrillation Perpetuated after Pulmonary Vein Isolation between Paroxysmal and Persistent Atrial Fibrillation: Effects of Subsequent Stepwise Ablation.
Difference in the Maintenance Mechanism of Atrial Fibrillation Perpetuated after Pulmonary Vein Isolation between Paroxysmal and Persistent Atrial Fibrillation: Effects of Subsequent Stepwise Ablation.
复制标题
阵发性和持续性心房颤动肺静脉隔离后持续存在的心房颤动维持机制的差异：后续逐步消融的影响。
DOI：
10.1016/j.ijcard.2016.02.092
复制
发表时间：
2016
影响因子：
3.5
通讯作者：
Hiroshige Yamabe
中科院分区：
文献类型：
--
作者：
山部浩茂;金澤尚徳;伊藤美和;金子祥三;金丸侑右;木山 卓也;辻田賢一;Yohei Ohno;Hitomi Horinouchi;Hiroshige Yamabe;Tsutomu Murakami;Yohei Ohno;Hiroshige Yamabe;Yohei Ohno;Hiroshige Yamabe
背景肺静脉隔离（PVI）后房颤（AF）维持机制和逐步消融终止房颤（AF）的机制尚不清楚。方法对226例连续房颤患者(154例阵发性房颤（P-AF）和72例持续性房颤（Per-AF）进行PVI后左心房心内膜非接触定位，其中10例P-AF和16例Per-AF患者进行PVI定位，确定房颤维持机制。随后，对所有患者进行逐步导管消融（线状屋顶病变和PVI后复杂分房电图（CFAE））的效果评估。结果在PVI后，AF通过孤立的PV/二尖瓣环周围的激活维持，在CFAE残余区域主要观察到病灶放电和无组织激活（旋转激活、波断和融合）。PVI后p - af的CFAE区域小于Per-AF（1.6±2.1 vs 7.7±2.5 cm2, p < 0.0001）。p - af的旋转激活、波断和融合频率低于Per-AF（1.9±2.0比11.8±5.0次/s， p < 0.0001, 0.1±0.3比3.6±2.5次/s， p < 0.001, 5.8±3.6比9.8±3.2次/s， p < 0.01）。AF终止在p -AF组比Per-AF组更常见（94.8% vs 81.9%, p = 0.0019）。在p -AF中，PVI单独导致房颤终止的发生率高于Per-AF （85.6% vs. 18.6%, p < 0.0001）。然而，经顶线和/或CFAE消融终止AF的p -AF患者少于Per-AF患者（14.4% vs. 81.4%, p < 0.0001）。结论PVI后的无组织激活与CFAE区域残留有关，在Per-AF中更为突出。大多数P-AF仅通过PVI终止，然而，需要额外的顶线病变和CFAE消融来终止Per-AF，这与制图结果一致。
BackgroundNeither the atrial fibrillation (AF) maintenance mechanism after pulmonary vein isolation (PVI) nor the mechanism of AF termination via stepwise ablation is clearly understood.MethodsAmong 226 consecutive AF patients (154 paroxysmal (P-AF) and 72 persistent AF (Per-AF) patients), left atrial endocardial non-contact mapping was performed after PVI in the initial 10 P-AF and 16 Per-AF patients to define the AF maintenance mechanism. Subsequently, effect of stepwise catheter ablation (linear roof lesion and complex fractionated atrial electrogram (CFAE) following PVI) was evaluated in all patients.ResultsAfter PVI, AF was maintained by the activation around isolated PV/mitral annulus, focal discharge and disorganized activations mostly observed over residual CFAE region (pivoting activation, wave break and fusion). CFAE region in P-AF was smaller than Per-AF after PVI (1.6 ± 2.1 vs. 7.7 ± 2.5 cm2, p < 0.0001). The frequency of pivoting activation, wave break and fusion in P-AF were lower than those in Per-AF (1.9 ± 2.0 vs. 11.8 ± 5.0 times/s; p < 0.0001, 0.1 ± 0.3 vs. 3.6 ± 2.5 times/s; p < 0.001, 5.8 ± 3.6 vs. 9.8 ± 3.2 times/s; p < 0.01). AF termination was more frequent in P-AF than Per-AF (94.8% vs 81.9%, p = 0.0019). AF termination by PVI alone was more frequent in P-AF than Per-AF (85.6% vs. 18.6%, p < 0.0001). However, AF termination via roof line and/or CFAE ablation was less frequent in P-AF than Per-AF (14.4 vs. 81.4%, p < 0.0001).ConclusionsDisorganized activations after PVI, more prominent in Per-AF, were associated with residual CFAE region. Most P-AF was terminated by PVI alone, however additional roof line lesion and CFAE ablation were necessary to terminate Per-AF, consistent with mapping results.