Kottkamp Hans, Tanner Hildegard, Kobza Richard, Schirdewahn Petra, Dorszewski Anja, Gerds-Li Jin-Hong, Carbucicchio Corrado, Piorkowski Christopher, Hindricks Gerhard
University of Leipzig, Heart Center, Cardiology, Department of Electrophysiology, Leipzig, Germany.
J Am Coll Cardiol. 2004 Aug 18;44(4):869-77. doi: 10.1016/j.jacc.2004.04.049.
We sought to analyze the time course of atrial fibrillation (AF) episodes before and after circular plus linear left atrial ablation and the percentage of patients with complete freedom from AF after ablation by using serial seven-day electrocardiograms (ECGs).
The curative treatment of AF targets the pathophysiological corner stones of AF (i.e., the initiating triggers and/or the perpetuation of AF). The pathophysiological complexity of both may not result in an "all-or-nothing" response but may modify number and duration of AF episodes.
In patients with highly symptomatic AF, circular plus linear ablation lesions were placed around the left and right pulmonary veins, between the two circles, and from the left circle to the mitral annulus using the electroanatomic mapping system. Repetitive continuous 7-day ECGs administered before and after catheter ablation were used for rhythm follow-up.
In 100 patients with paroxysmal (n = 80) and persistent (n = 20) AF, relative duration of time spent in AF significantly decreased over time (35 +/- 37% before ablation, 26 +/- 41% directly after ablation, and 10 +/- 22% after 12 months). Freedom from AF stepwise increased in patients with paroxysmal AF and after 12 months measured at 88% or 74% depending on whether 24-h ECG or 7-day ECG was used. Complete pulmonary vein isolation was demonstrated in <20% of the circular lesions.
The results obtained in patients with AF treated with circular plus linear left atrial lesions strongly indicate that substrate modification is the main underlying pathophysiologic mechanism and that it results in a delayed cure instead of an immediate cure.
我们试图通过连续7天的心电图（ECG）分析环肺静脉加线性左心房消融术前和术后房颤（AF）发作的时间进程，以及消融后无房颤患者的百分比。
房颤的根治性治疗针对房颤的病理生理基石（即房颤的起始触发因素和/或持续存在因素）。两者的病理生理复杂性可能不会导致“全或无”的反应，而是可能改变房颤发作的次数和持续时间。
对于症状严重的房颤患者，使用电解剖标测系统在左右肺静脉周围、两个环之间以及从左环到二尖瓣环放置环形加线性消融灶。导管消融术前和术后重复进行连续7天的心电图检查以进行节律随访。
在100例阵发性（n = 80）和持续性（n = 20）房颤患者中，房颤持续的相对时间随时间显著减少（消融前为35±37%，消融后立即为26±41%，12个月后为10±22%）。阵发性房颤患者无房颤的比例逐步增加，12个月后，根据使用24小时心电图还是7天心电图，测得的比例为88%或74%。在不到20%的环形病灶中实现了完全肺静脉隔离。
环肺静脉加线性左心房病灶治疗房颤患者的结果强烈表明，基质改良是主要的潜在病理生理机制，其导致的是延迟治愈而非立即治愈。
