Nonpulmonary vein foci: Do they exist?
Nonpulmonary vein foci: Do they exist?
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DOI：
10.1046/j.1460-9592.2003.t01-1-00243.x
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发表时间：
2003-07-01
影响因子：
1.8
通讯作者：
Hocini, M
中科院分区：
文献类型：
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作者：
Shah, D;Haissaguerre, M;Hocini, M
尽管大多数触发心房颤动 (AF) 的病灶已定位到肺静脉 (PV)，但隔离所有四个肺静脉后阵发性 AF 复发表明存在其他病灶。在一系列接受 PV 消融的 160 名连续患者中，对 AF 和 PV 隔离后复发的异位进行了心内膜标测。 36 名患者 (24%) 共有 85 个非 PV 病灶； 39 个被映射到被消融的 PV 口，30 个被映射到左后心房 (LA)，5 个被映射到 LA 的其他部分，5 个被映射到右心房 (RA)，4 个被映射到冠状窦 (CS)，3 个被映射到上腔静脉 (SVC)（包括 1 个持续性左 SVC）。通过成功的消融证实了映射。至少 16 个病灶无法定位，经过 8 +/- 6 个月的随访，68% 的患者在没有任何抗心律失常治疗的情况下没有发生房颤。非 PV 病灶的发生与 AF 复发相关，可能与孔口消融不足相关。这些数据强化了通过在 LA 内进行消融来更近端断开 PV 的要求。对于难以用传统方式标测的非 PV 病灶的患者，使用表面心电图数据、或多电极接触或非接触标测阵列、或基质修改/排除消融可能有助于消融这些病灶，从而消除 AF。
Though the majority of foci triggering atrial fibrillation (AF) have been mapped to the pulmonary veins (PV), recurrence of paroxysmal AF after isolation of all four pulmonary veins indicates the presence of other foci. In a series of 160 consecutive patients who underwent PV ablation, endocardial mapping of AF and ectopy recurring after PV isolation was performed. Thirty-six patients (24%) had a total of 85 non-PV foci; 39 were mapped to the ostia of ablated PVs, 30 to the posterior left atrium (LA), 5 to other parts of the LA, 5 to the right atrium (RA), 4 to the coronary sinus (CS), and 3 to the superior vena cava (SVC) (including one persistent left SVC). Mapping was confirmed by successful ablation. At least 16 foci could not be localized and after a follow-up of 8 +/- 6 months, 68% of patients were free of AF without any antiarrhythmic treatment. The occurrence of non-PV foci correlated with recurrence of AF, perhaps as a correlate of insufficient ostial ablation. These data reinforce the requirement for more proximal disconnection of the PVs by performing ablation within the LA. In patients with non-PV foci that are difficult to map conventionally, the use of surface ECG data, or multielectrode contact or noncontact mapping arrays, or substrate modifying/excluding ablation may be helpful in ablating these foci and therefore eliminating AF.