Achievement of pulmonary vein isolation in patients undergoing circumferential pulmonary vein ablation: A randomized comparison between two different isolation approaches
Achievement of pulmonary vein isolation in patients undergoing circumferential pulmonary vein ablation: A randomized comparison between two different isolation approaches
复制标题
环肺静脉消融患者肺静脉隔离的实现：两种不同隔离方法的随机比较
DOI：
10.1111/j.1540-8167.2006.00621.x
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发表时间：
2006-12-01
影响因子：
2.7
通讯作者：
Ma, Changsheng
中科院分区：
文献类型：
--
作者：
Liu, Xingpeng;Dong, Jianzeng;Ma, Changsheng
不同肺静脉隔离方法的比较。简介：以肺静脉电隔离为终点的环肺静脉消融（CPVA）已被开发为治疗心房颤动（AF）的有效方法。该终点可通过沿环形线闭合沿着间隙或在创建初始CPVA病变后在环形线内进行节段性肺静脉隔离来实现。我们调查了临床结果是否取决于首次CPVA procedure.Methods和Results期间使用的PV隔离方法：100例连续患者（69例男性;年龄，56.7 +/- 11.6岁）首次接受CPVA治疗症状性AF。随机通过单独CPVA（积极CPVA [A-CPVA]组，n = 50）或CPVA与节段性肺静脉口消融（改良CPVA [M-CPVA]组，n = 50）联合实现肺静脉隔离。首次手术后3个月内，M-CPVA组有30例（60%）患者复发房性快速性心律失常（ATa），而A-CPVA组仅有15例（30%）患者（P < 0.01）。前3个月后，M-CPVA组中有21例患者（42%）检测到ATa复发，而A-CPVA组中有9例患者（18%）（P = 0.01）。在13 +/- 4个月时，接受A-CPVA入路治疗的患者比接受M-CPVA治疗的患者有更高的无房性心动过速复发率（P = 0.01）。结论：以肺静脉隔离为CPVA治疗终点时，A-CPVA方法的疗效优于M-CPVA方法。
Comparison of Different Pulmonary Vein Isolation Approaches. Introduction: Circumferential pulmonary vein ablation (CPVA) with the endpoint of pulmonary vein (PV) isolation has been developed as an effective therapy for atrial fibrillation (AF). This endpoint can be achieved either by closing gaps along circular lines or by segmental PV isolation inside the circular lines after creation of initial CPVA lesions. We investigated whether the clinical outcome depends on the PV isolation approach used during the first-time CPVA procedure.Methods and Results: One hundred consecutive patients (69 male; age, 56.7 +/- 11.6 years) who underwent first-time CPVA for treatment of symptomatic AF were enrolled. PV isolation was randomly achieved either by CPVA alone (aggressive CPVA [A-CPVA] group, n = 50) or by a combination of CPVA with segmental PV ostia ablation (modified CPVA [M-CPVA] group, n = 50). Recurrence of atrial tachyarrhythmias (ATa) within 3 months after the initial procedure occurred in 30 patients (60%) in the M-CPVA group and in only 15 patients (30%) in the A-CPVA group (P < 0.01). ATa relapse after the first 3 months was detected in 21 patients (42%) in the M-CPVA group, compared with 9 patients (18%) in the A-CPVA group (P = 0.01). At 13 +/- 4 months, patients treated by the A-CPVA approach had greater freedom from ATa recurrence than patients who underwent M-CPVA (P = 0.01). The M-CPVA approach was the only independent predictor associated with procedural failure (RR 0.318; 95% CI 0.123 - 0.821; P = 0.02).Conclusions: When PV isolation is the endpoint of CPVA, the efficacy of the A-CPVA approach is better than that of M-CPVA.