Hsieh Ming-Hsiung, Tai Ching-Tai, Lee Shih-Huang, Lin Yung-Kuo, Tsao Hsuan-Ming, Chang Shih-Lin, Lin Yenn-Jiang, Wongchaoen Wanwarang, Lee Kun-Tai, Chen Shih-Ann
Division of Cardiovascular Medicine, Department of Medicine, Taipei Medical University School of Medicine, and Taipei Wan-Fang Hospital, Taipei, Taiwan.
J Cardiovasc Electrophysiol. 2006 Mar;17(3):231-5. doi: 10.1111/j.1540-8167.2005.00323.x.
The mechanisms of late (<1 year after the ablation) and very late (>1 year after the ablation) recurrences of paroxysmal atrial fibrillation (AF) after catheter ablation have not been reported.
Fifty consecutive patients undergoing a repeated electrophysiologic study to investigate the recurrence of paroxysmal AF after the first ablation were included. Group 1 consisted of 12 patients with very late (26 +/- 13 months) and group 2 consisted of 38 patients with late (3 +/- 3 months) recurrence of paroxysmal AF. In the baseline study, group 1 had a lower incidence of AF foci from the pulmonary veins (PVs) (67% vs 92%, P = 0.048) and a higher incidence of AF foci from the right atrium (50% vs 13%, P = 0.014) than group 2. In the repeated study, group 1 had a higher incidence of AF foci from the right atrium (67% vs 3%, P < 0.001) and a lower incidence of AF foci from the left atrium (50% vs 97%, P < 0.001), including a lower incidence of AF foci from the PVs (50% vs 79%, P = 0.07) and from the left atrial free wall (0% vs 29%, P = 0.046) than group 2. Furthermore, most of these AF foci (64% of group 1, 65% of group 2) were from the previously targeted foci.
The right atrial foci played an important role in the very late recurrence of AF, whereas the left atrial foci (the majority were PVs) were the major origin of the late recurrence of AF after the catheter ablation of paroxysmal AF.
阵发性心房颤动（AF）导管消融术后晚期（消融后<1年）和极晚期（消融后>1年）复发的机制尚未见报道。
纳入50例连续接受重复电生理检查以探究首次消融后阵发性AF复发情况的患者。第1组由12例极晚期（26±13个月）复发患者组成，第2组由38例晚期（3±3个月）复发患者组成。在基线研究中，第1组肺静脉（PVs）AF病灶发生率低于第2组（67%对92%，P = 0.048），右心房AF病灶发生率高于第2组（50%对13%，P = 0.014）。在重复研究中，第1组右心房AF病灶发生率高于第2组（67%对3%，P<0.001），左心房AF病灶发生率低于第2组（50%对97%，P<0.001），包括PVs（50%对79%，P = 0.07）和左心房游离壁（0%对29%，P = 0.046）AF病灶发生率低于第2组。此外，这些AF病灶大多（第1组64%，第2组65%）来自先前靶向的病灶。
右心房病灶在AF极晚期复发中起重要作用，而左心房病灶（多数为PVs）是阵发性AF导管消融术后AF晚期复发的主要起源。
