Late Gadolinium Enhancement Magnetic Resonance Imaging Guided Treatment of Post-Atrial Fibrillation Ablation Recurrent Arrhythmia
Late Gadolinium Enhancement Magnetic Resonance Imaging Guided Treatment of Post-Atrial Fibrillation Ablation Recurrent Arrhythmia
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DOI：
10.1161/circep.119.007174
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发表时间：
2019-08-01
影响因子：
8.4
通讯作者：
Marrouche, Nassir F.
中科院分区：
文献类型：
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作者：
Fochler, Franziska;Yamaguchi, Takanori;Marrouche, Nassir F.
背景：巨大折返性房性心动过速(AT)占房颤(AF)术后复发性房性心律失常的40%~60%。为了描述晚期Gd增强磁共振成像(LGE-MRI)检测到的基于疤痕的消融作为治疗房颤消融后ATS的新策略。方法：对102例复发性房性心律失常患者在1年内行首次房颤消融和重复消融的临床资料进行分析。所有患者在初次消融和再次消融前均行LGE-MRI检查。根据复发节律的不同，房颤和房颤复发患者分别被分为1组和2组。第一组行肝纤维化匀浆，作为第二次手术。第2组采用LGE-MRI检测的瘢痕剥离术。必要时两组均行肺静脉再隔离术。结果：46例(45%)患者出现房颤，56例(55%)患者在首次消融后的随访中出现房颤复发。在第二组的前25名患者中，对房室进行了电解剖标测，并确定了临界峡部。LGE-MRI发现这些峡部位于非穿壁性瘢痕区域。在来自第二组的最后31例患者中，仅根据LGE-MRI结果进行了基于LGE-MRI的经验性拆线。二次消融后1年随访，组1无复发67%，组2无复发%(P=1.000)。在第2组中，解剖导引组的无复发(LOG-RANK，P=0.900)，LGE-MRI去毛刺组无复发的有65%(LOG-RANK)。结论：解剖靶向LGE-MRI显示的缝隙和浅层心房瘢痕是治疗房颤消融术后复发心律失常的可行和有效的方法。对于复发的房颤，均质化现有的瘢痕是合适的治疗方法，而对于复发的房颤患者，似乎是正确的方法是去除现有的峡部。
Background: Macroreentrant 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. Methods: Data 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. Results: Forty-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). Conclusions: Anatomic 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.