Electrophysiological breakthroughs from the left atrium to the pulmonary veins
Electrophysiological breakthroughs from the left atrium to the pulmonary veins
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DOI：
10.1161/01.cir.102.20.2463
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发表时间：
2000-11-14
期刊：
影响因子：
37.8
通讯作者：
Clémenty, J
中科院分区：
文献类型：
--
作者：
Haïssaguerre, M;Shah, DC;Clémenty, J
背景：从左心房开始心房颤动的肺静脉（PV）心肌延伸电切断所需的口部消融程度尚未确定。方法与结果：70例患者在窦性心律或左心房起搏期间行10电极周导管PV测图。在评估了PV电位的周长分布和激活顺序后，在最早激活的节段进行了切口消融，以PV断开为终点。共切除了162个pv（不包括右下pv）。PV电位存在于其周长的60%至88%，但PV肌的激活总是从最早激活的部分（突破）开始。该突破的射频（RE）应用消除了34个PV的所有PV电位，而第二次突破则需要在77个单独的段进行射频应用；在其他病例中，切除bb22节段。环形导管的中位数为5、6和4个双极，分别定位于右上、左上和下PV，以实现PV断开。在31例患者中，由于新的静脉或心房病灶或先前靶向pv的恢复，观察到心律失常的早期复发，大多数与局部射频应用的单一恢复突破有关。结论：尽管PV肌覆盖了PV周长的很大一部分，但从左心房有特定的突破，可以通过使用部分周长消融使PV口断开。
Background-The extent of ostial ablation necessary to electrically disconnect the pulmonary vein (PV) myocardial extensions that initiate atrial fibrillation from the left atrium has not been determined.Methods and Results-Seventy patients underwent PV mapping with a circumferential 10-electrode catheter during sinus rhythm or left atrial pacing. After assessment of perimetric distribution and activation sequence of PV potentials, ostial ablation was performed at segments showing earliest activation, with the end point of PV disconnection. A total of 162 PVs (excluding right inferior PVs) were ablated. PV potentials were present at 60% to 88% df their perimeter, but PV muscle activation was always sequential from a segment with earliest activation (breakthrough). Radiofrequency (RE) application at this breakthrough eliminated all PV potentials in 34 PVs, whereas a secondary breakthrough required RF applications at separate segments in 77; in others, >2 segments were ablated. A median of 5, 6, and 4 bipoles from the circular catheter were targeted in the right superior, left superior, and inferior PVs, respectively, to achieve PV disconnection. Early recurrence of arrhythmia was observed in 31 patients as a result of new venous or atrial foci or recovery of previously targeted PVs, most related to a single recovered breakthrough that was reablated with local RF application.Conclusions-Although PV muscle covers a large extent of the PV perimeter, there are specific breakthroughs from the left atrium that allow ostial PV disconnection by use of partial perimetric ablation.