Pappone C, Oreto G, Rosanio S, Vicedomini G, Tocchi M, Gugliotta F, Salvati A, Dicandia C, Calabrò M P, Mazzone P, Ficarra E, Di Gioia C, Gulletta S, Nardi S, Santinelli V, Benussi S, Alfieri O
Department of Cardiology, San Raffaele University Hospital, Milan, Italy.
Circulation. 2001 Nov 20;104(21):2539-44. doi: 10.1161/hc4601.098517.
Circumferential radiofrequency ablation around pulmonary vein (PV) ostia has recently been described as a new anatomic approach for atrial fibrillation (AF).
We treated 251 consecutive patients with paroxysmal (n=179) or permanent (n=72) AF. Circular PV lesions were deployed transseptally during sinus rhythm (n=124) or AF (n=127) using 3D electroanatomic guidance. Procedures lasted 148+/-26 minutes. Among 980 lesions surrounding individual PVs (n=956) or 2 ipsilateral veins with close openings or common ostium (n=24), 75% were defined as complete by a bipolar electrogram amplitude <0.1 mV inside the lesion and a delay >30 ms across the line. The amount of low-voltage encircled area was 3594+/-449 mm(2), which accounted for 23+/-9% of the total left atrial (LA) map surface. Major complications (cardiac tamponade) occurred in 2 patients (0.8%). No PV stenoses were detected by transesophageal echocardiography. After 10.4+/-4.5 months, 152 patients with paroxysmal AF (85%) and 49 with permanent AF (68%) were AF-free. Patients with and without AF recurrence did not differ in age, AF duration, prevalence of heart disease, or ejection fraction, but the LA diameter was significantly higher (P<0.001) in permanent AF patients with recurrence. The proportion of PVs with complete lesions was similar between patients with and without recurrence, but the latter had larger low-voltage encircled areas after radiofrequency (expressed as percent of LA surface area; P<0.001).
Circumferential PV ablation is a safe and effective treatment for AF. Its success is likely due to both PV trigger isolation and electroanatomic remodeling of the area encompassing the PV ostia.
肺静脉（PV）口周围的环形射频消融术最近被描述为一种治疗心房颤动（AF）的新解剖学方法。
我们连续治疗了251例阵发性（n = 179）或永久性（n = 72）AF患者。在三维电解剖学引导下，于窦性心律（n = 124）或房颤（n = 127）期间经房间隔进行环形PV损伤。手术持续148±26分钟。在围绕单个PV（n = 956）或2个开口相近或有共同开口的同侧静脉（n = 24）的980个损伤中，75%被定义为完全损伤，即损伤内部双极电图振幅<0.1 mV且跨线延迟>30 ms。低电压环绕区域的面积为3594±449 mm²，占左心房（LA）总标测面积的23±9%。主要并发症（心脏压塞）发生在2例患者（0.8%）。经食管超声心动图未检测到PV狭窄。10.4±4.5个月后，152例阵发性AF患者（85%）和49例永久性AF患者（68%）无房颤发作。有房颤复发和无房颤复发的患者在年龄、房颤持续时间、心脏病患病率或射血分数方面无差异，但复发的永久性AF患者的LA直径显著更高（P<0.001）。有复发和无复发的患者中具有完全损伤的PV比例相似，但后者在射频消融后低电压环绕区域更大（以LA表面积的百分比表示；P<0.001）。
环形PV消融是一种治疗AF的安全有效方法。其成功可能归因于PV触发灶的隔离以及PV口周围区域的电解剖重塑。
