Chugh Aman, Oral Hakan, Lemola Kristina, Hall Burr, Cheung Peter, Good Eric, Tamirisa Kamala, Han Jihn, Bogun Frank, Pelosi Frank, Morady Fred
Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan 48109-0311, USA.
Heart Rhythm. 2005 May;2(5):464-71. doi: 10.1016/j.hrthm.2005.01.027.
The purpose of this study was to determine the prevalence and clinical significance of macroreentrant atrial tachycardia (AT) after left atrial (LA) circumferential ablation for atrial fibrillation (AF).
Linear ablation for AF may result in macroreentrant AT.
Three hundred forty-nine patients (age 54 +/- 11 years) underwent LA circumferential ablation for AF (paroxysmal in 227). Ablation lines were created around the left-sided and right-sided pulmonary veins, with additional ablation lines in the posterior LA and mitral isthmus. If macroreentrant AT was observed acutely in the electrophysiology laboratory, it was not ablated. If an organized AT occurred during follow-up, the initial strategy was rate control. If AT persisted for > 3 to 4 months, catheter ablation was performed.
Seventy-one patients (20%) had spontaneous or induced macroreentrant AT (cycle length 244 +/- 31 ms) in the electrophysiology laboratory following LA circumferential ablation. During follow-up, 85 patients (24%) experienced spontaneous AT (cycle length 238 +/- 35 ms) at a mean of 44 +/- 62 days following LA circumferential ablation. Among the 71 patients with macroreentrant AT acutely following LA circumferential ablation, 39 (55%) developed AT during follow-up. Among the 85 patients with AT during follow-up, the tachycardia remitted without a repeat ablation procedure in 28 patients (33%), most commonly within 5 months. Twenty-eight of the 349 patients (8%) underwent a repeat ablation procedure for AT. The critical isthmus was localized to the mitral isthmus in 17 of 28 patients (61%).
Macroreentrant AT is a common form of proarrhythmia after LA circumferential ablation for AF. Because it may resolve spontaneously, ablation of AT should be deferred for several months.
本研究旨在确定左心房（LA）环周消融治疗心房颤动（AF）后大折返性房性心动过速（AT）的发生率及临床意义。
AF的线性消融可能导致大折返性AT。
349例患者（年龄54±11岁）接受了LA环周消融治疗AF（阵发性AF患者227例）。在左、右肺静脉周围创建消融线，并在后壁LA和二尖瓣峡部增加消融线。如果在电生理实验室中急性观察到大折返性AT，则不进行消融。如果在随访期间发生有组织的AT，初始策略是控制心率。如果AT持续>3至4个月，则进行导管消融。
71例患者（20%）在LA环周消融后的电生理实验室中出现自发或诱发的大折返性AT（周长244±31毫秒）。随访期间，85例患者（24%）在LA环周消融后平均44±62天出现自发AT（周长238±35毫秒）。在LA环周消融后急性出现大折返性AT的71例患者中，39例（55%）在随访期间发生AT。在随访期间发生AT的85例患者中，28例（33%）的心动过速在未重复消融的情况下缓解，最常见于5个月内。349例患者中有28例（8%）因AT接受了重复消融。28例患者中有17例（61%）的关键峡部定位于二尖瓣峡部。
大折返性AT是LA环周消融治疗AF后常见的心律失常形式。由于其可能自发缓解，AT的消融应推迟数月。
