Recurrent atrial arrhythmias in the setting of chronic pulmonary vein isolation
Recurrent atrial arrhythmias in the setting of chronic pulmonary vein isolation
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DOI：
10.1016/j.hrthm.2016.08.026
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发表时间：
2016-11-01
期刊：
影响因子：
5.5
通讯作者：
Marchlinski, Francis E.
中科院分区：
文献类型：
--
作者：
Sadek, Mouhannad M.;Maeda, Shingo;Marchlinski, Francis E.
背景：持续性肺静脉电隔离（PVI）后仍可能发生房性心律失常。目的：本研究的目的是探讨慢性PVI后再次行消融治疗心律失常的患者的发生率及其临床结局。从这一人群中，我们确定了慢性肺静脉隔离患者。临床特征，消融策略，和outcomes.Results之间2003年1月至2013年12月，1045例患者进行了1298重复左心房手术。其中，900例患者患有房颤（AF），145例患者患有房扑（AFL）/房性心动过速（AT）。52例患者（5.0%; 27例AF和25例AFL/AT）患有慢性肺静脉隔离，并被纳入本研究。患者随访19.7 +/- 5.6个月。在AF患者中，11例（41%）确定了非肺静脉触发因素。消融策略包括非肺静脉触发消融（n = 11）、经验性肺静脉部位消融（n = 3）、诱发性心律失常消融（n = 9）、复杂碎裂心房电图消融（n = 2）和线性消融（n = 2）。随访期间，9例（33%）无复发，7例（26%）罕见房颤（≥ 1年），11例（41%）房颤复发。在AFL/AT患者中，12例（48%）无复发，4例（16%）罕见复发（≥ 1年），9例（36%）复发。结论：在研究期间接受重复手术的PVI患者中，只有一小部分有慢性PVI。针对房颤的非肺静脉触发因素和房扑/房性心动过速的线性/局灶性消融的策略可在大多数患者中实现长期心律失常控制。(C)2016心脏节律协会。All rights reserved.
BACKGROUND Atrial arrhythmias may still occur in patients after durable pulmonary vein isolation (PVI).OBJECTIVE The purpose of this study was to examine the incidence of patients undergoing ablation for recurrent arrhythmia despite chronic PVI and their clinical outcomes.METHODS Patients undergoing repeat left atrial ablation procedures were selected from a prospective registry. From this population, we identified patients with chronic PVI. Clinical characteristics, ablation strategies, and outcomes were analyzed.RESULTS Between January 2003 and December 2013, 1045 patients underwent 1298 repeat left atrial procedures. Of these, 900 patients had atrial fibrillation (AF) and 145 had atrial flutter (AFL)/atrial tachycardia (AT). Fifty-two patients (5.0%; 27 with AF and 25 with AFL/AT) had chronic PVI and were included in the study. Patients were followed for 19.7 +/- 5.6 months. In patients with AF, 11 (41%) had a non-PV trigger identified. Ablation strategies included non-PV trigger ablation (n = 11), empiric trigger-site ablation (n = 3), provoked arrhythmia ablation (n = 9), complex fractionated atrial electrogram ablation (n = 2), and linear ablation (n = 2). During follow-up, 9 (33%) had no recurrence, 7 (26%) had rare AF (= 1 year), and 11 (41%) had AF recurrence. In patients with AFL/AT, 12 (48%) had no recurrence, 4 (16%) had rare recurrence (= 1 year), and 9 (36%) had recurrence.CONCLUSION In patients with PVI undergoing a repeat procedure during the time period studied, only a small portion had chronic PVI. A strategy of targeting non-PV triggers for AF and linear/focal ablation for AFL/AT may achieve long-term arrhythmia control in the majority of patients. (C) 2016 Heart Rhythm Society. All rights reserved.