Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation - A prospective randomized study comparing circumferential pulmonary vein ablation with a modified approach
Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation - A prospective randomized study comparing circumferential pulmonary vein ablation with a modified approach
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DOI：
10.1161/01.cir.0000147186.83715.95
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发表时间：
2004-11-09
期刊：
影响因子：
37.8
通讯作者：
Santinelli, V
中科院分区：
文献类型：
--
作者：
Pappone, C;Manguso, F;Santinelli, V
背景-环肺静脉消融（CPVA）可有效治愈心房颤动（AF），但新发左房性心动过速（AT）是一种潜在的并发症。我们评估了改良的 CPVA 方法（包括在后壁和二尖瓣峡部附加消融线）是否会降低 PV 消融后 AT 的发生率。 方法和结果 - 共有 560 名患者（291 名男性，52%；年龄，56.5+/-7.3 岁）进入研究； 280 名患者被随机分配至单独 CPVA（第 1 组），280 名患者被随机分配至改良 CPVA（第 2 组）。主要终点是手术后摆脱 AT。在第 1 组中，28 名患者 (10%) 经历了新发 AT，41 名患者 (14.3%) 经历了复发性 AF。在第 2 组中，11 名患者 (3.9%) 经历过 AT，36 名患者 (12.9%) 患有复发性 AF。第 1 组比第 2 组更有可能经历 AT (P=0.005)。两组消融后房颤的缓解情况相似 (P=0.57)。在第 1 组患者中，28 名患者中有 23 名 (82%) 记录了间隙相关的大折返 AT，5 名患者 (18%) 发现局灶性 AT。在第 2 组中，11 名患者中有 8 名 (73%) 发现了间隙相关的大折返 AT，3 名患者 (27%) 发现了局灶性 AT。第 1 组中的 2 名患者和第 2 组中的 1 名患者同时患有 AT 和 AF。 AT 最强的预测因子是间隙的存在 (P
Background-Circumferential pulmonary vein ablation (CPVA) is effective in curing atrial fibrillation (AF), but new-onset left atrial tachycardia ( AT) is a potential complication. We evaluated whether a modified CPVA approach including additional ablation lines on posterior wall and the mitral isthmus would reduce the incidence of AT after PV ablation.Methods and Results-A total of 560 patients (291 men, 52%; age, 56.5+/-7.3 years) entered the study; 280 were randomized to CPVA alone ( group 1) and 280 to modified CPVA ( group 2). The primary end point was freedom from AT after the procedure. In group 1, 28 patients (10%) experienced new-onset AT, and 41 (14.3%) experienced recurrent AF. In group 2, 11 patients (3.9%) experienced AT, and 36 (12.9%) had recurrent AF. Group 1 was more likely to experience AT than group 2 (P=0.005). Freedom from AF after ablation was similar in both groups (P=0.57). Among those in group 1, gap-related macroreentrant AT was documented in 23 of the 28 patients (82%), and focal AT was found in 5 (18%). In group 2, gap-related macroreentrant AT was found in 8 of the 11 patients (73%), and focal AT was seen in 3 (27%). Two patients in group 1 and 1 patient in group 2 had both AT and AF. The strongest predictor of AT was the presence of gaps (P