Razavi Mehdi, Zhang Shulong, Delapasse Scott, Yang Donghui, Ai Tomohiko, Kar Biswajit, Younis George, Rasekh Abdi, Cheng Jie
Texas Heart Institute/St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Pacing Clin Electrophysiol. 2006 Nov;29(11):1201-8. doi: 10.1111/j.1540-8159.2006.00524.x.
Pulmonary vein isolation (PVI) has been shown to suppress atrial fibrillation (AF). We examined the effects of PVI on disorganization and dominant frequencies (DF) in patients with permanent AF.
Twenty-eight patients with permanent AF (>6 months) who failed > or =1 antiarrhythmic drugs (AAD) and > or =2 cardioversions (CV) with AF reversion <30 minutes after CV were included. PVI and isolation of DFs in pulmonary veins (PVs) was performed during AF. Fast Fourier transformations of atrial electrograms were performed. Disorganization index (DI) was defined as the percentage of time spent in type III AF during 1-minute continuous recordings. The temporal stability and reproducibility of DIs from the same sites were verified over time prior to ablation. Highly disorganized AF activity concentrated in the posterior left atrium (PLA) including sites at the left atrial (PV-LA) junction (55.7% of sites in PLA, 32.9% in septum, and 11.4% in other sites). DF and DI from the coronary sinus (CS) before and after PVI were analyzed. PVI reduced the DI (14.3 +/- 25.0% before PVI vs 4.6 +/- 8.6% after PVI; P < 0.02). There was significant reduction of DI in 26 of 28 patients. The DF remained unchanged (5.6 +/- 1.3 Hz before PVI vs 5.9 +/- 0.9 Hz after PVI; P = 0.31). After a follow-up of 30 +/- 11 months, 15 (54%) of patients are free of symptomatic AF, 3 (10%) in sinus rhythm on AAD, 5 (18%) with paroxysmal AF, 4 (14%) in chronic AF, and 1 (4%) with atypical flutter.
In the vast majority of patients with chronic AF, PVI reduces AF disorganization without affecting the DF as measured in the CS.
肺静脉隔离（PVI）已被证明可抑制心房颤动（AF）。我们研究了PVI对永久性AF患者心房电活动紊乱和主导频率（DF）的影响。
纳入28例永久性AF（>6个月）患者，这些患者使用≥1种抗心律失常药物（AAD）治疗失败且≥2次心脏复律（CV），复律后AF持续时间<30分钟。在AF期间进行PVI及肺静脉（PV）主导频率的隔离。对心房电图进行快速傅里叶变换。紊乱指数（DI）定义为1分钟连续记录期间III型AF持续时间的百分比。在消融前，对同一部位DI的时间稳定性和可重复性进行了验证。高度紊乱的AF活动集中在左心房后壁（PLA），包括左心房（PV-LA）交界处的部位（PLA中占55.7%的部位，间隔中占32.9%，其他部位占11.4%）。分析了PVI前后冠状窦（CS）的DF和DI。PVI降低了DI（PVI前为14.3±25.0%，PVI后为4.6±8.6%；P<0.02）。28例患者中有26例DI显著降低。DF保持不变（PVI前为5.6±1.3Hz，PVI后为5.9±0.9Hz；P = 0.31）。经过30±11个月的随访，15例（54%）患者无有症状的AF，3例（10%）在服用AAD情况下处于窦性心律，5例（18%）为阵发性AF，4例（14%）为慢性AF，1例（4%）为非典型房扑。
在绝大多数慢性AF患者中，PVI可降低AF的紊乱程度，而不影响CS中测量的DF。
