Haïssaguerre M, Jaïs P, Shah D C, Arentz T, Kalusche D, Takahashi A, Garrigue S, Hocini M, Peng J T, Clémenty J
Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
J Cardiovasc Electrophysiol. 2000 Jan;11(1):2-10. doi: 10.1111/j.1540-8167.2000.tb00727.x.
We assessed the mode of reinitiation of atrial fibrillation (AF) after cardioversion and the efficacy of ablating these foci of reinitiation in patients with chronic AF.
Fifteen patients, 7 with structural heart disease, underwent mapping and catheter ablation of drug-resistant AF documented to be persistent for 5 +/- 4 months. In all patients, cardioversion was followed by documentation of P on T atrial ectopy and early recurrence, which allowed mapping of the reinitiating trigger or the source of ectopy. Radiofrequency (RF) ablation was performed at pulmonary vein (PV) ostia using a target temperature of 50 degrees C and a power limit of 30 to 40 W, with the endpoint being interruption of all local muscle conduction. A total of 32 arrhythmogenic PVs and 2 atrial foci (left septum and left appendage) were identified: 1, 2, and 3 or 4 PVs in 5, 3, and 6 patients. RF applications at the ostial perimeter resulted in progressively increasing delay, followed by abolition of PV potentials in 8, but potentials persisted in 6. A single ablation session was performed in 7 patients and 8 underwent two or three sessions because of recurrence of AF; ablation was directed at the same source due to recovery of local PV potential or at a different PV. No PV stenosis was noted either acutely or at repeated follow-up angiograms. Nine patients (60%) were in stable sinus rhythm without antiarrhythmic drugs at follow-up of 11 +/- 8 months. Anticoagulants were interrupted in 7 patients.
PVs are the dominant triggers reinitiating chronic AF in this patient population. Elimination of PV potentials by ostial RF applications results in stable sinus rhythm in 60%. A larger group and longer follow-up are needed to investigate further the role of trigger ablation in curative therapy for chronic AF.
我们评估了心脏复律后房颤（AF）重新起始的模式以及在慢性房颤患者中消融这些重新起始病灶的疗效。
15例患者，其中7例有结构性心脏病，接受了对记录为持续5±4个月的药物难治性房颤的标测和导管消融。在所有患者中，心脏复律后记录到P波落在T波上的房性早搏和早期复发，这使得能够标测重新起始的触发因素或早搏的来源。在肺静脉（PV）开口处进行射频（RF）消融，目标温度为50℃，功率限制为30至40W，终点是所有局部肌肉传导中断。共识别出32个致心律失常的PV和2个心房病灶（左间隔和左心耳）：5例、3例和6例患者分别有1个、2个和3或4个PV。在开口周边进行RF应用导致延迟逐渐增加，随后8例患者的PV电位消失，但6例患者的电位持续存在。7例患者进行了单次消融，8例因房颤复发接受了两到三次消融；由于局部PV电位恢复或针对不同的PV，消融针对相同的来源。急性或重复随访血管造影均未发现PV狭窄。9例患者（60%）在11±8个月的随访中未使用抗心律失常药物维持稳定的窦性心律。7例患者中断了抗凝治疗。
在该患者群体中，PV是重新起始慢性房颤的主要触发因素。通过开口处RF应用消除PV电位可使60%的患者维持稳定的窦性心律。需要更大的样本量和更长时间的随访来进一步研究触发因素消融在慢性房颤治疗中的作用。
