Dechanneling Left Atrial Late Gadolinium Enhancement: An Imaging Moon Shot?
Dechanneling Left Atrial Late Gadolinium Enhancement: An Imaging Moon Shot?
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左心房晚期钆去通道增强：成像登月计划？
DOI：
10.1161/circep.119.007683
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Marchlinski,Francis
中科院分区：
文献类型：
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作者：
Nazarian,Saman;Marchlinski,Francis
背景：大重入性房性心动过速（AT）占房颤（AF）消融后复发性心房心律失常的40% - 60%。描述晚期钆增强磁共振成像（LGE-MRI）检测的基于瘢痕的去通道作为治疗房颤消融后ATs的新消融策略。方法回顾性分析102例复发性心房心律失常患者1年内首次房颤消融和反复房颤消融的资料。所有患者在初始消融和重复消融前均行大磁共振成像检查。根据复发节律，AF和AT复发患者分别被分配到1组或2组。第1组第二步行纤维化均质化。第2组行lge - mri检测的基于瘢痕的去通道。如有必要，两组均行肺静脉再隔离。结果在术后随访中，46例（45%）出现房颤，56例（55%）出现房颤复发。在第2组的前25例患者中，对AT进行了电解剖图绘制，并定义了临界峡部。结果发现，这些峡部位于大磁共振成像检测到的非跨壁瘢痕区。在第二组的最后31例患者中，仅根据LGE-MRI结果进行经验性的基于LGE-MRI的去通道。在第二次消融后1年随访中，1组67%的患者和2组64%的患者无复发（log-rank，P=1.000）。在第2组中，64%的电解剖引导组和65%的LGE-MRI脱通道组无复发（log-rank，P=0.900）。结论大磁共振成像（lge - mri）检测间隙及浅表心房瘢痕的原子靶向治疗房颤消融后复发性心律失常是可行且有效的。对于复发性房颤，瘢痕均质化是合适的治疗方法，而对于复发性房颤患者，对现有峡部进行疏通似乎是正确的方法。
BackgroundMacroreentrant atrial tachycardia (AT) accounts for 40% to 60% of recurrent atrial arrhythmias after atrial fibrillation (AF) ablation. To describe late gadolinium enhancement magnetic resonance imaging (LGE-MRI)–detected scar-based dechanneling as new ablation strategy to treat ATs after AF ablation.MethodsData from 102 patients who underwent initial AF ablation and repeat ablation for recurrent atrial arrhythmia within 1-year follow-up were analyzed. All patients underwent LGE-MRI before initial and repeat ablation. Depending on the recurrent rhythm, patients with AF and AT recurrence were assigned to group 1 or 2, respectively. Group 1 underwent fibrosis homogenization as second procedure. Group 2 underwent LGE-MRI–detected scar-based dechanneling. Both groups underwent reisolation of pulmonary veins if necessary.ResultsForty-six patients (45%) presented with AF, and 56 patients (55%) presented with AT recurrence during follow-up after initial ablation. In the first 25 patients from group 2, the AT was electroanatomically mapped, and a critical isthmus was defined. It was found that those isthmi were located in the regions with nontransmural scarring detected by LGE-MRI. In the last 31 patients from group 2, an empirical LGE-MRI–based dechanneling was performed solely based on the LGE-MRI results. During 1-year follow-up after second ablation, 67% patients in group 1 and 64% patients in group 2 were free from recurrence (log-rank,P=1.000). In group 2, 64% in the electroanatomically guided and 65% in the LGE-MRI dechanneling group were free from recurrence (log-rank,P=0.900).ConclusionsAnatomic targeting of LGE-MRI–detected gaps and superficial atrial scar is feasible and effective to treat recurrent arrhythmias post-AF ablation. Homogenization of existing scar is the appropriate treatment for recurrent AF, whereas dechanneling of existing isthmi seems the right approach for patients recurring with AT.