Changes in atrial fibrillation cycle length and inducibility during catheter ablation and their relation to outcome
Changes in atrial fibrillation cycle length and inducibility during catheter ablation and their relation to outcome
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DOI：
10.1161/01.cir.0000130645.95357.97
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发表时间：
2004-06-22
期刊：
影响因子：
37.8
通讯作者：
Jaïs, P
中科院分区：
文献类型：
--
作者：
Haïssaguerre, M;Sanders, P;Jaïs, P
背景-人类导管消融过程中房颤周期长度（AFCL）的改变尚未被评估。方法和结果：70例接受长时间房颤消融术的患者被随机分配到肺静脉隔离或二尖瓣峡部的额外消融术组。在消融前、2- pv和4-PV隔离后以及线性消融后，在距离消融区（冠状动脉窦）一定距离处测定平均AFCL。测定消融前后持续房颤的诱导性（大于或等于10分钟）。30例患者出现自发性持续性房颤（715 +/- 845分钟），26例患者发生诱发性房颤（AFCL， 186 +/- 19毫秒）。PV隔离导致75%的AF终止，随着AF持续时间的延长，需要隔离的PV数量增加（P = 0.018）。PV分离导致不同程度的进行性或突然性AFCL延长，这取决于PV: AF终止时延长至214 +/- 24 ms (P < 0.0001)， AF持续时延长至194 +/- 19 ms （P = 0.002）。房颤终止患者AFCL的增加（30 +/- 17 ms vs 14 +/- 11 ms, P = 0.005）和碎片化的减少（30.0 +/- 26.8% vs 10.3 +/- 14.5%, P < 0.0001）明显更大。线性消融延长AFCL， AF终止患者延长时间更长（44 +/- 13 ms vs 22 +/- 23 ms; P = 0.08）。PV分离后持续房颤不可诱导率为57%，线性消融后不可诱导率为77%。在7 +/- 3个月时，74%的PV隔离组和83%的线性消融组无心律失常且无抗心律失常药物，这与非诱导性显著相关（P = 0.03），诱导性和非诱导性患者的复发率分别为38%和13%。结论：房颤消融导致房颤频率下降，其程度与房颤的终止和诱发性的预防相关，可预测随后的临床结果。
Background - The modification of atrial fibrillation cycle length (AFCL) during catheter ablation in humans has not been evaluated.Methods and Results - Seventy patients undergoing ablation of prolonged episodes of AF were randomized to pulmonary vein (PV) isolation or additional ablation of the mitral isthmus. Mean AFCL was determined at a distance from the ablated area ( coronary sinus) at the following intervals: before ablation, after 2- and 4-PV isolations, and after linear ablation. Inducibility of sustained AF ( greater than or equal to 10 minutes) was determined before and after ablation. Spontaneous sustained AF ( 715 +/- 845 minutes) was present in 30 patients and induced in 26 ( AFCL, 186 +/- 19 ms). PV isolation terminated AF in 75%, with the number of PVs requiring isolation before termination increasing with AF duration ( P = 0.018). PV isolation resulted in progressive or abrupt AFCL prolongation to various extents, depending on the PV: to 214 +/- 24 ms ( P < 0.0001) when AF terminated and to 194 +/- 19 ms ( P = 0.002) when AF persisted. The increase in AFCL ( 30 +/- 17 versus 14 +/- 11 ms; P = 0.005) and the decrease in fragmentation ( 30.0 +/- 26.8% to 10.3 +/- 14.5%; P < 0.0001) were significantly greater in patients with AF termination. Linear ablation prolonged AFCL, with a greater prolongation in patients with AF termination ( 44 +/- 13 versus 22 +/- 23 ms; P = 0.08). Sustained AF was noninducible in 57% after PV isolation and in 77% after linear ablation. At 7 +/- 3 months, 74% with PV isolation and 83% with linear ablation were arrhythmia free without antiarrhythmics, which was significantly associated with noninducibility ( P = 0.03) with a recurrence rate of 38% and 13% in patients with and without inducibility, respectively.Conclusions - AF ablation results in a decline in AF frequency, with a magnitude correlating with termination of AF and prevention of inducibility that is predictive of subsequent clinical outcome.