Oral Hakan, Knight Bradley P, Ozaydin Mehmet, Chugh Aman, Lai Steve W K, Scharf Christoph, Hassan Sohail, Greenstein Radmira, Han Jihn D, Pelosi Frank, Strickberger S Adam, Morady Fred
Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0022, USA.
Circulation. 2002 Sep 3;106(10):1256-62. doi: 10.1161/01.cir.0000027821.55835.00.
The purpose of this study was to determine the feasibility and mechanistic implications of segmental pulmonary vein (PV) ostial ablation during atrial fibrillation (AF).
Forty consecutive patients underwent PV isolation for AF. Among 125 PVs targeted for isolation, ablation was performed during AF in 70 veins and during sinus rhythm in 55 veins. A decapolar Lasso catheter was positioned near the ostium. During AF, ostial ablation was performed near the Lasso catheter electrodes that recorded a tachycardia with a cycle length shorter than in the adjacent left atrium. During sinus rhythm, ostial ablation was guided by PV potentials. Complete PV isolation was achieved in 70 PVs (100%) ablated during AF and in 53 PVs (96%) ablated during sinus rhythm (P=0.4). The mean durations of radiofrequency energy needed for isolation were 7.4+/-4.4 and 5.2+/-3.9 minutes during AF and sinus rhythm, respectively (P<0.01). Before ablation, an immediate recurrence of AF (IRAF), occurred after cardioversion in 18 of 40 patients, and IRAF was consistently abolished by PV isolation. The probability of AF termination during isolation of a PV was directly related to the extent of tachycardia in that vein. As more PVs were isolated, induction of persistent AF by rapid pacing became less likely.
Segmental ostial ablation guided by PV tachycardia during AF is feasible and as efficacious as during sinus rhythm. The responses to cardioversion, ablation, and rapid pacing observed in this study imply that IRAF is triggered by the PVs and that PV tachycardias may play an important role in the perpetuation of AF.
本研究的目的是确定心房颤动（AF）期间节段性肺静脉（PV）开口消融的可行性及其机制意义。
连续40例患者接受了针对房颤的肺静脉隔离术。在125条目标隔离肺静脉中，70条在房颤期间进行消融，55条在窦性心律期间进行消融。将十极套索导管置于开口附近。在房颤期间，在记录到心动周期长度短于相邻左心房的套索导管电极附近进行开口消融。在窦性心律期间，开口消融由肺静脉电位引导。在房颤期间消融的70条肺静脉（100%）和窦性心律期间消融的53条肺静脉（96%）实现了完全肺静脉隔离（P=0.4）。房颤和窦性心律期间隔离所需的平均射频能量持续时间分别为7.4±4.4分钟和5.2±3.9分钟（P<0.01）。消融前，40例患者中有18例在复律后出现房颤即刻复发（IRAF），而IRAF通过肺静脉隔离持续消除。肺静脉隔离期间房颤终止的概率与该静脉心动过速的程度直接相关。随着更多肺静脉被隔离，快速起搏诱发持续性房颤的可能性降低。
房颤期间由肺静脉心动过速引导的节段性开口消融是可行的，且与窦性心律期间一样有效。本研究中观察到的对复律、消融和快速起搏的反应表明，IRAF由肺静脉触发，并且肺静脉心动过速可能在房颤持续存在中起重要作用。
