Tojo Hideaki, Kumagai Koichiro, Noguchi Hiroo, Ogawa Masahiro, Yasuda Tomoo, Nakashima Hideko, Zhang Bo, Miura Shin-ichiro, Saku Keijiro
Department of Cardiology, Fukuoka University Hospital, Japan.
Circ J. 2005 Dec;69(12):1503-7. doi: 10.1253/circj.69.1503.
Pulmonary vein (PV) isolation is commonly performed in patients with drug-refractory atrial fibrillation (AF) and in cases of unsuccessful ablation, antiarrhythmic agents that were ineffective before the ablation sometimes become effective afterward. Therefore, the effects and mechanisms of hybrid therapy with pilsicainide and PV isolation for AF were assessed in the present study.
Seventy-four patients with paroxysmal AF in whom pilsicainide was ineffective underwent PV isolation. If AF recurred, a second procedure was performed and if AF recurred again, pilsicainide was re-administered. After the first procedure, AF recurred in 42 patients, and a second procedure was performed in 31 patients, of whom 28 had recovery of left atrial (LA)-PV conduction and non-PV foci were identified in 3. After the second session, ablation eliminated AF without drugs in 53 (72%) patients. Pilsicainide suppressed the conduction properties at the LA-PV junction. In 21 patients with recurrence of AF, pilsicainide was re-administered and eliminated AF in 11 patients (success with pilsicainide: 86%).
In cases of unsuccessful PV isolation, pilsicainide may prevent AF by modifying the LA-PV conduction properties. Hybrid therapy with pilsicainide and PV isolation may be an effective therapeutic approach for AF.
肺静脉（PV）隔离常用于药物难治性心房颤动（AF）患者，在消融失败的病例中，消融前无效的抗心律失常药物有时在消融后会变得有效。因此，本研究评估了吡西卡尼与PV隔离联合治疗AF的效果及机制。
74例使用吡西卡尼无效的阵发性AF患者接受了PV隔离。如果AF复发，则进行第二次手术，如果AF再次复发，则重新给予吡西卡尼。第一次手术后，42例患者AF复发，31例患者进行了第二次手术，其中28例恢复了左心房（LA）-PV传导，3例发现非PV病灶。第二次手术后，53例（72%）患者在未使用药物的情况下消融消除了AF。吡西卡尼抑制了LA-PV连接处的传导特性。在21例AF复发的患者中，重新给予吡西卡尼，11例患者AF消除（吡西卡尼治疗成功：86%）。
在PV隔离失败的病例中，吡西卡尼可能通过改变LA-PV传导特性来预防AF。吡西卡尼与PV隔离联合治疗可能是一种有效的AF治疗方法。
