Nakashima Hideko, Kumagai Koichiro, Noguchi Hiroo, Tojo Hideaki, Yasuda Tomoo, Saku Keijiro
Department of Cardiology, Fukuoka University School of Medicine, Nanakuma 7-45-1, Jonan-ku, Fukuoka 814-0180.
J Cardiol. 2002 Sep;40(3):87-94.
The mechanism of the recurrence of atrial fibrillation after pulmonary vein ablation was evaluated.
Eighty patients with atrial fibrillation underwent pulmonary vein ablation. If extrasystoles or atrial fibrillation initiations were frequent, focal ablation was performed at the site of the earliest activation. If the patient had little or no ectopy, all pulmonary veins with distinct and late pulmonary vein potentials were targeted for pulmonary vein isolation, which was achieved by minimal segmental ablation limited to the ostial site with the earliest pulmonary vein potentials.
Focal ablation or pulmonary vein isolation was performed in 42 and 38 patients, respectively. After focal ablation, atrial fibrillation recurred in 23 patients and re-ablation was performed in 10:7 at sites near the previous source, 2 at a different part of the same pulmonary vein, and 1 at a different pulmonary vein. After pulmonary vein isolation, atrial fibrillation recurred in 19 patients and re-ablation was performed in 14:8 due to recovery of atrio-pulmonary vein conduction, 3 at non-pulmonary vein foci, 2 at pulmonary vein ostia proximal to the previous pulmonary vein isolation, and 1 at a different pulmonary vein.
After focal ablation, atrial fibrillation recurred from other foci in the same pulmonary vein or other pulmonary veins. Therefore, three or four pulmonary veins should be isolated. However, atrial fibrillation recurred after pulmonary vein isolation due to the recovery of atrio-pulmonary vein conduction or non-pulmonary vein foci. Further development of new mapping and ablation systems to detect the foci and create a complete lesion at the pulmonary vein ostium may be necessary.
评估肺静脉消融术后房颤复发的机制。
80例房颤患者接受了肺静脉消融术。如果早搏或房颤发作频繁，则在最早激动部位进行局灶性消融。如果患者几乎没有或没有异位搏动，则将所有具有明显且延迟的肺静脉电位的肺静脉作为肺静脉隔离的目标，通过仅限于最早肺静脉电位的开口部位的最小节段性消融来实现。
分别对42例和38例患者进行了局灶性消融或肺静脉隔离。局灶性消融后，23例患者房颤复发，其中10例再次消融：7例在先前起源部位附近，2例在同一肺静脉的不同部位，1例在不同肺静脉。肺静脉隔离后，19例患者房颤复发，其中14例再次消融：8例由于肺静脉传导恢复，3例在非肺静脉灶，2例在先前肺静脉隔离部位近端的肺静脉开口处，1例在不同肺静脉。
局灶性消融后，房颤从同一肺静脉或其他肺静脉的其他病灶复发。因此，应隔离三或四条肺静脉。然而，肺静脉隔离后房颤复发是由于肺静脉传导恢复或非肺静脉灶。可能需要进一步开发新的标测和消融系统以检测病灶并在肺静脉开口处形成完整的损伤。
