Fassini Gaetano, Riva Stefania, Chiodelli Roberta, Trevisi Nicola, Berti Marco, Carbucicchio Corrado, Maccabelli Giuseppe, Giraldi Francesco, Bella Paolo Della
Institute of Cardiology Fondazione Monzino, University of Milan, Italy.
J Cardiovasc Electrophysiol. 2005 Nov;16(11):1150-6. doi: 10.1111/j.1540-8167.2005.50192.x.
The deployment of an ablation line connecting the left inferior PV to the mitral annulus (mitral isthmus line [MIL]) enhances the efficacy of pulmonary vein disconnection (PVD) in preventing atrial fibrillation (AF) recurrences.
To investigate the long-term effect of the additional linear lesion in a prospective randomized study.
One hundred and eighty-seven patients (37 females, mean age: 55 +/- 11 years) with paroxysmal (126) or persistent (61 patients) AF, were prospectively randomized into two groups: PVD (group A, 92 patients) or PVD combined with MIL (group B, 95 patients), performed by means of an irrigated-tip ablation catheter.
Successful disconnection of all PVs was achieved in all patients. A bidirectional block (BB) along the left atrial isthmus was obtained in 72 of 95 (76%) patients in group B, most of whom required additional RF pulses from within the distal CS. A transient ischemic attack occurred in 1 patient of group A, and a cardiac tamponade occurred in 1 patient of group B. At 1 year, 53 +/- 5% (group A) and 71 +/- 5% (group B) remained arrhythmia free (P = 0.01); subgroup analysis highlights a higher improvement among patients with persistent AF (74 +/- 9% vs 36 +/- 9%; P < 0.01) than what was observed in paroxysmal AF (76 +/- 6% vs 62 +/- 6%; P < 0.05); antiarrhythmic drugs were continued in 56% and 50%, respectively, in groups A and B (P = ns).
The addition of mitral isthmus line to the PV disconnection allows a significant improvement of sinus rhythm maintenance rate, particularly in patients with persistent AF, without the risk for major complications.
部署一条连接左下肺静脉与二尖瓣环的消融线（二尖瓣峡部线[MIL]）可提高肺静脉隔离（PVD）预防房颤（AF）复发的疗效。
在一项前瞻性随机研究中调查附加线性病变的长期效果。
187例阵发性（126例）或持续性（61例）房颤患者（37例女性，平均年龄：55±11岁），前瞻性随机分为两组：PVD组（A组，92例患者）或PVD联合MIL组（B组，95例患者），通过灌注式消融导管进行操作。
所有患者均成功实现所有肺静脉的隔离。B组95例患者中有72例（76%）在左房峡部获得双向阻滞（BB），其中大多数患者需要从冠状静脉窦远端内部施加额外的射频脉冲。A组有1例患者发生短暂性脑缺血发作，B组有1例患者发生心脏压塞。1年时，A组53±5%和B组71±5%患者无心律失常复发（P = 0.01）；亚组分析显示，持续性房颤患者的改善程度更高（74±9%对36±9%；P < 0.01），高于阵发性房颤患者（76±6%对62±6%；P < 0.05）；A组和B组分别有56%和50%的患者继续使用抗心律失常药物（P = 无显著性差异）。
在肺静脉隔离基础上增加二尖瓣峡部线可显著提高窦性心律维持率，尤其是持续性房颤患者，且无重大并发症风险。
