Sanders Prashanthan, Hocini Mélèze, Jaïs Pierre, Sacher Fréderic, Hsu Li-Fern, Takahashi Yoshihide, Rotter Martin, Rostock Thomas, Nalliah Chrishan J, Clémenty Jacques, Haïssaguerre Michel
Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux-II, Bordeaux, France.
Eur Heart J. 2007 Aug;28(15):1862-71. doi: 10.1093/eurheartj/ehl548.
To evaluate the contribution of the posterior left atrium (LA) to chronic atrial fibrillation (AF).
Twenty-seven patients with chronic-AF were studied. After pulmonary vein (PV) isolation, the posterior-LA was isolated by ablation joining the right- and left-PVs using an irrigated-tip catheter. Isolation was demonstrated by absent/dissociated posterior-LA activity and the inability to pace the region. Ablation impact was determined by the effect on cycle length (CL) and AF termination. Posterior-LA isolation was achieved using 35 +/- 12 min of radiofrequency with total fluoroscopic and procedural durations of 64 +/- 16 and 199 +/- 46 min, resulting in abolition of electrograms (n = 21) or autonomous activity (n = 6; CL 820 +/- 343 ms). AFCL increased from 156 +/- 28 ms to 162 +/- 27 ms with PV-isolation and to 175 +/- 32 ms by posterior-LA exclusion (P < 0.0001). AF persisted in all after PV-isolation and terminated in 5 (19%) during posterior-LA-isolation. After 10 +/- 6 months, 12 patients developed atrial tachycardia (four) or AF (eight); four underwent repeat posterior-LA-isolation, while the others required additional ablation/antiarrhythmics. After 21 +/- 5 months, 17 (63%) were in sinus rhythm following posterior-LA-isolation.
This study demonstrates the feasibility of complete posterior-LA exclusion by catheter ablation. This strategy results in maintenance of sinus rhythm in 63% at 2 years follow-up.
评估左心房后壁对慢性心房颤动的作用。
对27例慢性心房颤动患者进行研究。在肺静脉隔离后，使用灌注导管通过连接右肺静脉和左肺静脉的消融来隔离左心房后壁。通过左心房后壁活动缺失/分离以及无法对该区域进行起搏来证实隔离。通过对周期长度（CL）和心房颤动终止的影响来确定消融的效果。使用35±12分钟的射频实现左心房后壁隔离，总透视时间和手术时间分别为64±16分钟和199±46分钟，导致电图消失（n = 21）或自主活动消失（n = 6；CL 820±343毫秒）。肺静脉隔离后房颤CL从156±28毫秒增加到162±27毫秒，左心房后壁排除后增加到175±32毫秒（P < 0.0001）。肺静脉隔离后所有患者房颤持续存在，左心房后壁隔离期间5例（19%）房颤终止。10±6个月后，12例患者出现房性心动过速（4例）或房颤（8例）；4例接受了重复左心房后壁隔离，其他患者需要额外的消融/抗心律失常治疗。21±5个月后，左心房后壁隔离后17例（63%）处于窦性心律。
本研究证明了通过导管消融完全排除左心房后壁的可行性。该策略在2年随访时使63%的患者维持窦性心律。
