Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions: trigger elimination or substrate modification: early or delayed cure?
Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions: trigger elimination or substrate modification: early or delayed cure?
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圆形加线性左心房病变后心房颤动发作次数和持续时间的时间过程和定量分析：触发消除或基质修改：早期或延迟治愈？
DOI：
10.1016/j.jacc.2004.04.049
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发表时间：
2004
影响因子：
24
通讯作者：
G. Hindricks
中科院分区：
文献类型：
--
作者：
H. Kottkamp;H. Tanner;R. Kobza;P. Schirdewahn;A. Dorszewski;J. Gerds;C. Carbucicchio;C. Piorkowski;G. Hindricks
目的我们试图通过连续 7 天心电图 (ECG) 分析循环加线性左心房消融前后心房颤动 (AF) 发作的时间过程以及消融后完全摆脱房颤的患者百分比。两者的病理生理学复杂性可能不会导致“全有或全无”的反应，但可能会改变 AF 发作的次数和持续时间。 方法在症状严重的 AF 患者中，使用电解剖标测系统在左右肺静脉周围、两个圆圈之间以及从左圆圈到二尖瓣环放置圆形加线性消融病灶。导管消融前后重复连续 7 天的心电图用于心律随访。 结果 在 100 名阵发性 (n = 80) 和持续性 (n = 20) AF 患者中，AF 的相对持续时间随时间显着减少（消融前为 35 ± 37%，消融后直接为 26 ± 41%，12 个月后为 10 ± 22%）。阵发性 AF 患者的 AF 缓解率逐步增加，12 个月后测量为 88% 或 74%，具体取决于使用 24 小时心电图还是 7 天心电图。 <20% 的圆形病变中显示出完全肺静脉隔离。 结论 在接受圆形加线性左心房病变治疗的 AF 患者中获得的结果强烈表明基质修饰是主要的潜在病理生理机制，并且它导致延迟治愈而不是立即治愈。
ObjectivesWe sought to analyze the time course of atrial fibrillation (AF) episodes before and after circular plus linear left atrial ablation and the percentage of patients with complete freedom from AF after ablation by using serial seven-day electrocardiograms (ECGs).BackgroundThe curative treatment of AF targets the pathophysiological corner stones of AF (i.e., the initiating triggers and/or the perpetuation of AF). The pathophysiological complexity of both may not result in an “all-or-nothing” response but may modify number and duration of AF episodes.MethodsIn patients with highly symptomatic AF, circular plus linear ablation lesions were placed around the left and right pulmonary veins, between the two circles, and from the left circle to the mitral annulus using the electroanatomic mapping system. Repetitive continuous 7-day ECGs administered before and after catheter ablation were used for rhythm follow-up.ResultsIn 100 patients with paroxysmal (n = 80) and persistent (n = 20) AF, relative duration of time spent in AF significantly decreased over time (35 ± 37% before ablation, 26 ± 41% directly after ablation, and 10 ± 22% after 12 months). Freedom from AF stepwise increased in patients with paroxysmal AF and after 12 months measured at 88% or 74% depending on whether 24-h ECG or 7-day ECG was used. Complete pulmonary vein isolation was demonstrated in <20% of the circular lesions.ConclusionsThe results obtained in patients with AF treated with circular plus linear left atrial lesions strongly indicate that substrate modification is the main underlying pathophysiologic mechanism and that it results in a delayed cure instead of an immediate cure.
影响因子：
4.6
作者：
COX, JL;BOINEAU, JP;CRAWFORD, FA
通讯作者：
CRAWFORD, FA