Yamada Takumi, Murakami Yoshimasa, Okada Taro, Okamoto Mitsuhiro, Shimizu Takeshi, Toyama Junji, Yoshida Yukihiko, Tsuboi Naoya, Ito Teruo, Muto Masahiro, Kondo Takahisa, Inden Yasuya, Hirai Makoto, Murohara Toyoaki
Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan.
Heart Rhythm. 2006 Apr;3(4):377-84. doi: 10.1016/j.hrthm.2005.12.027.
How extensive should an appropriate pulmonary vein (PV) ablation be is a matter of controversy.
The study's aim was to investigate the efficacy of minimally extensive PV ablation for isolating the PV antrum (PVA) with the guidance of electrophysiological parameters.
Fifty-five consecutive symptomatic paroxysmal atrial fibrillation (PAF) patients underwent PV mapping with a multielectrode basket catheter (MBC). A 31-mm MBC was deployed in 3-4 PVs as proximally as possible without dislodgement, and the longitudinal PV mapping enabled us to recognize single sharp potentials formed by the total fusion of the PV and left atrial potentials around the PV ostium or the transverse activation patterns that were observed. Those potentials were defined as PVA potentials. Radiofrequency ablation was performed circumferentially targeting PVA potentials with the end point being their elimination.
After circumferential PVA ablation, electrical disconnection was achieved in 77% and residual PVA conduction gaps were observed in 23% of all targeted PVs. Those residual conduction gaps were mainly located at the border between ipsilateral PVs (42%) and between the left PVs and left atrial appendage (33%) and were eliminated by a mean of 3 +/- 2 minutes of local radiofrequency deliveries. During the follow-up period (11 +/- 5 months), 46 (84%) patients were free of symptomatic PAF without any anti-arrhythmic drugs. No PV stenosis or spontaneous left atrial flutter occurred.
Electrophysiological PVA ablation with an MBC is feasible and effective for curing PAF because this minimally extensive PVA isolation technique targets the optimal sites, achieving both high efficacy and safety.
合适的肺静脉（PV）消融范围应多大存在争议。
本研究旨在探讨在电生理参数指导下进行最小范围PV消融以隔离肺静脉前庭（PVA）的疗效。
55例连续的有症状阵发性心房颤动（PAF）患者接受了多电极篮状导管（MBC）肺静脉标测。将31毫米的MBC尽可能靠近地部署在3 - 4条肺静脉中且不发生移位，纵向肺静脉标测使我们能够识别在肺静脉口周围由肺静脉和左心房电位完全融合形成的单个尖锐电位或观察到的横向激动模式。这些电位被定义为PVA电位。围绕PVA电位进行环周射频消融，终点为其消除。
环周PVA消融后，所有目标肺静脉中有77%实现了电隔离，23%观察到残留的PVA传导间隙。这些残留传导间隙主要位于同侧肺静脉之间的边界（42%）以及左肺静脉与左心耳之间（33%），通过平均3±2分钟的局部射频发放得以消除。在随访期（11±5个月）内，46例（84%）患者在未使用任何抗心律失常药物的情况下无症状性PAF发作。未发生肺静脉狭窄或自发性左房扑动。
使用MBC进行电生理PVA消融治疗PAF是可行且有效的，因为这种最小范围的PVA隔离技术靶向最佳部位，实现了高疗效和安全性。
