Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation
Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation
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DOI：
10.1161/01.cir.0000112641.16340.c7
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发表时间：
2004-01-27
期刊：
影响因子：
37.8
通讯作者：
Alfieri, O
中科院分区：
文献类型：
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作者：
Pappone, C;Santinelli, V;Alfieri, O
背景-目前尚无数据评价环肺静脉消融（CPVA）后自主神经功能改变与复发性心房颤动（AF）之间的关系。本研究评估了射频迷走神经去神经控制在预防阵发性房颤复发方面的增加益处。方法和结果-收集了297例阵发性房颤接受CPVA的患者的数据。所有肺静脉口周围所有诱发的迷走神经反射的消除被定义为完全的迷走神经去神经控制（CVD）， 34.3%的患者获得。随访12个月。心率变异性衰减与迷走神经戒断一致，在CPVA后长达3个月内可检测到，特别是在有反射性和CVD的患者中，与没有反射性的患者相比，他们复发房颤的可能性更小（P = 0.0002， log-rank检验）。只有左心房隔离面积百分比和CVD是CPVA后房颤复发的预测因子（分别P < 0.001和P = 0.025）。结论：本研究表明，CPVA期间辅助CVD可显著降低房颤12个月的复发率。
Background - There are no data to evaluate the relationship between autonomic nerve function modification and recurrent atrial fibrillation (AF) after circumferential pulmonary vein ablation (CPVA). This study assesses the incremental benefit of vagal denervation by radiofrequency in preventing recurrent AF in a large series of patients undergoing CPVA for paroxysmal AF.Methods and Results - Data were collected on 297 patients undergoing CPVA for paroxysmal AF. Abolition of all evoked vagal reflexes around all pulmonary vein ostia was defined as complete vagal denervation (CVD) and was obtained in 34.3% of patients. Follow-up ended at 12 months. Heart rate variability attenuation, consistent with vagal withdrawal, was detectable for up to 3 months after CPVA, particularly in patients with reflexes and CVD, who were less likely to have recurrent AF than those without reflexes ( P = 0.0002, log-rank test). Only the percentage area of left atrial isolation and CVD were predictors of AF recurrence after CPVA ( P < 0.001 and P = 0.025, respectively).Conclusions - This study suggests that adjunctive CVD during CPVA significantly reduces recurrence of AF at 12 months.