Oral Hakan, Chugh Aman, Scharf Christoph, Hall Burr, Cheung Peter, Veerareddy Srikar, Daneshvar Gerald F, Pelosi Frank, Morady Fred
Division of Cardiology, TC B1 140D, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0311, USA.
J Cardiovasc Electrophysiol. 2004 Apr;15(4):402-6. doi: 10.1046/j.1540-8167.2004.03432.x.
Based on the clinical history, paroxysmal atrial fibrillation (PAF) may be classified as vagotonic, adrenergic, or random. It is unclear whether pulmonary vein (PV) isolation is equally effective for these types of PAF.
Segmental ostial ablation to isolate the PVs was performed in 188 consecutive patients (mean age 53 +/- 12 years) with PAF. Based on the clinical history, PAF was classified as random in 136 patients (72%), adrenergic in 30 (16%), and vagotonic in 22 (12%). Three or four PVs were targeted for isolation in all patients, and successful isolation was achieved in 96% of targeted PVs. At 1-year follow-up, 69% of patients with random AF, 83% of patients with adrenergic AF, and 50% of patients with vagotonic AF were free from recurrent episodes of AF in the absence of any antiarrhythmic drug therapy. Vagotonic AF was an independent clinical predictor of recurrent AF (P = 0.03).
PV isolation has a lower efficacy in patients with vagotonic PAF than in patients with adrenergic or random episodes of PAF, suggesting that the PVs less often play an important role in vagotonic PAF.
根据临床病史，阵发性心房颤动（PAF）可分为迷走神经型、肾上腺素能型或随机型。目前尚不清楚肺静脉（PV）隔离对这些类型的PAF是否同样有效。
对188例连续的PAF患者（平均年龄53±12岁）进行节段性肺静脉口部消融以隔离肺静脉。根据临床病史，136例患者（72%）的PAF被分类为随机型，30例（16%）为肾上腺素能型，22例（12%）为迷走神经型。所有患者均针对三或四条肺静脉进行隔离，96%的目标肺静脉实现了成功隔离。在1年的随访中，在未使用任何抗心律失常药物治疗的情况下，69%的随机型房颤患者、83%的肾上腺素能型房颤患者和50%的迷走神经型房颤患者未出现房颤复发。迷走神经型房颤是房颤复发的独立临床预测因素（P = 0.03）。
与肾上腺素能型或随机型PAF患者相比，肺静脉隔离在迷走神经型PAF患者中的疗效较低，这表明肺静脉在迷走神经型PAF中发挥重要作用的情况较少见。
