Pulmonary vein isolation as an end point for left atrial circumferential ablation of atrial fibrillation
Pulmonary vein isolation as an end point for left atrial circumferential ablation of atrial fibrillation
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DOI：
10.1016/j.jacc.2005.05.069
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发表时间：
2005-09-20
影响因子：
24
通讯作者：
Morady, F
中科院分区：
文献类型：
--
作者：
Lemola, K;Oral, H;Morady, F
目的：我们试图确定消除肺静脉（PV）心律失常是否对左房环心消融（LACA）治疗心房颤动（AF）的疗效有必要。PV通常是房颤的触发或驱动因素。研究表明，在消除阵发性房颤方面，LACA比PV隔离更有效。然而，目前尚不清楚是否需要完全隔离PV才能达到LACA的疗效。方法连续60例阵发性（39例）或慢性（21例）房颤患者（平均年龄53 +/- 12岁），在电解剖导航系统的引导下，行LACA环绕左、右侧pv，并在左心房后部和二尖瓣峡部附加线。在LACA前后分别用去极环导管对pv进行定位。如果PV隔离不完整，则不尝试完全隔离。结果60例患者中有48例（80%）在LACA后出现一个或多个pv的不完全电隔离。术前PV型心动过速的发生率为82%，术后为8% （p < 0.001）。随访11 +/- 1个月时，经抗心律失常药物治疗，12例PV完全分离患者中10例（83%）和48例PV不完全分离患者中39例（81%）无房颤复发（p = 1.0）。成功的结果与每位患者完全分离pv的数量无关（p = 0.6）。结论：左房环壁消融术可改变左房室内的致心律失常底物。在LACA之后，pv的完全电气隔离并不是成功结果的必要条件。
OBJECTIVES We sought to determine whether elimination of pulmonary vein (PV) arrhythmogenicity is necessary for the efficacy of left atrial circumferential ablation (LACA) for atrial fibrillation (AF).BACKGROUND The PVs often provide triggers or drivers of AF. It has been shown that LACA is more effective than PV isolation in eliminating paroxysmal AF. However, it is not clear whether complete PV isolation is necessary for the efficacy of LACA.METHODS In 60 consecutive patients with paroxysmal (n = 39) or chronic (n = 21) AF (mean age 53 +/- 12 years), LACA to encircle the left- and right-sided PVs, with additional lines in the posterior left atrium and along the mitral isthmus, was performed under the guidance of an electroanatomic navigation system. The PVs were mapped with a decapolar ring catheter before and after LACA. If PV isolation was incomplete, no attempts at complete isolation were made.RESULTS After LACA, there was incomplete electrical isolation of one or more PVs in 48 (80%) of the 60 patients. The prevalence of PV tachycardias was 82% before and 8% after LACA (p < 0.001). At 11 +/- 1 months of follow-up,10 (83%) of the 12 patients with complete and 39 (81%) of 48 patients with incomplete PV isolation were free from recurrent AF without antiarrhythmic drug therapy (p = 1.0). A successful outcome was not related to the number of completely isolated PVs per patient (p = 0.6).CONCLUSIONS Left atrial circumferential ablation modifies the arrhythmogenic substrate within the PVs. Complete electrical isolation of the PVs is not a requirement for a successful outcome after LACA.