Characterization, Mapping, and Catheter Ablation of Recurrent Atrial Tachycardias After Stepwise Ablation of Long-Lasting Persistent Atrial Fibrillation
Characterization, Mapping, and Catheter Ablation of Recurrent Atrial Tachycardias After Stepwise Ablation of Long-Lasting Persistent Atrial Fibrillation
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DOI：
10.1161/circep.109.899021
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发表时间：
2010-04-01
影响因子：
8.4
通讯作者：
Willems, Stephan
中科院分区：
文献类型：
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作者：
Rostock, Thomas;Drewitz, Imke;Willems, Stephan
背景-房性心动过速(AT)通常发生在长期持续性房颤(CAF)消融后，且难以保守治疗。这项研究评估了常规标测和导管消融治疗CAF分步消融后晚期复发房颤的机制和成功率。方法和结果：2006-2007年间，共有320名患者采用分步消融方法进行CAF消融。这项研究包括了在初次房颤消融后的第一次重做手术中出现复发房颤的患者。所有程序都完全由传统的测绘技术指导。61例患者(63+/-10岁，14名女性)在初次消融后7.7+/-4.4个月出现临床房颤。总共绘制了133个AT图(每个患者2.2+/-0.9)。44例(72%)是由于折返；17例(28%)是局灶性ATS。再入房颤主要表现为房顶扑动和周缘扑动(分别为43%和34%)。局限性ATS主要起源于胸大静脉(肺静脉41%，冠状静脉23%)。45例(74%)患者至少有1条肺静脉传导恢复(平均1.2+/-0.8)。总体而言，124例(93%)房颤消融成功。平均手术时间181±59分钟，平均透视时间45±21分钟。经过平均21+/-4个月的随访，50例(82%)患者在一次重复手术后无任何心律失常复发。结论：尽管晚期复发的ATS可能有复杂的机制，但完全由传统技术指导的导管消融是非常有效的，具有良好的急性和远期成功率。(CIRC节律电生理。2010；3：160-169。)
Background-Atrial tachycardias (AT) often occur after ablation of long-lasting persistent AF (CAF) and are difficult to treat conservatively. This study evaluated mechanisms and success rates of conventional mapping and catheter ablation of recurrent ATs occurring late after stepwise ablation of CAF.Methods and Results-A total of 320 patients underwent de novo ablation of CAF using a stepwise ablation approach in 2006 to 2007 at our institution. This study comprised patients who presented with recurrent ATs at their first redo procedure after initial de novo CAF ablation. All procedures were guided by conventional mapping techniques exclusively. Sixty-one patients (63 +/- 10 years, 14 women) presented with their clinical AT at their redo procedure 7.7 +/- 4.4 months after initial de novo CAF ablation. A total of 133 ATs (2.2 +/- 0.9 per patient) were mapped. Forty-four (72%) were due to reentry; 17 (28%) were focal ATs. Reentry ATs were mainly characterized as roof and perimitral flutter (43% and 34%, respectively). Focal ATs mainly originated from the great thoracic veins (pulmonary veins: 41%, coronary sinus: 23%). Forty-five (74%) patients had conduction recovery of at least 1 pulmonary vein (mean, 1.2 +/- 0.8). Overall, 124 (93%) ATs could be ablated successfully. The mean procedure duration was 181 +/- 59 minutes, with a mean fluoroscopy time of 45 +/- 21 minutes. After a mean follow-up of 21 +/- 4 months, 50 (82%) patients were free of any arrhythmia recurrences after a single redo procedure.Conclusions-Although late recurrent ATs may have complex mechanisms, catheter ablation guided exclusively by conventional techniques is highly effective with excellent acute and long-term success rates. (Circ Arrhythm Electrophysiol. 2010;3:160-169.)