Haissaguerre M, Fischer B, Labbé T, Lemétayer P, Montserrat P, d'Ivernois C, Dartigues J F, Warin J F
Service de Cardiologie, Hôpital Saint-André, Bordeaux, France.
Am J Cardiol. 1992 Feb 15;69(5):493-7. doi: 10.1016/0002-9149(92)90992-8.
The effect of successful catheter ablation of overt accessory pathways on the incidence of atrial fibrillation (AF) was studied in 129 symptomatic patients with (n = 75) or without (n = 54) previous documented AF. Fourteen had had ventricular fibrillation. Factors predictive of recurrence were examined, including electrophysiologic parameters. Atrial vulnerability was defined as induction of sustained AF (greater than 1 minute) using single, then double, atrial extrastimuli at 2 basic pacing cycle lengths. When compared to patients with only reciprocating tachycardia, patients with clinical AF included more men (77 vs 54%, p = 0.008) and were older (35 +/- 12 vs 29 +/- 12 years, p = 0.01). They had a significantly shorter cycle length leading to anterograde accessory pathway block (252 +/- 42 vs 298 +/- 83 ms, p less than 0.001), greater incidences of atrial vulnerability (89 vs 24%, p less than 0.001) and subsequent need for cardioversion (51 vs 15%, p less than 0.001). After discharge, the follow-up period was 35 +/- 12 months (range 18 to 76); 7 patients with previous spontaneous AF (9%) had recurrence at a mean of 10 months after ablation. Age, presence of structural heart disease accessory pathway location, atrial refractory periods and accessory pathway anterograde conduction parameters were not predictive of AF recurrence. Persistence of atrial vulnerability after ablation was the only factor associated with further recurrence of AF. Atrial vulnerability was observed after ablation in only 56% of patients with previous AF versus 89% before ablation. It is concluded that successful catheter ablation of accessory pathways prevents further recurrence of AF in 91% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
在129例有症状的患者中，研究了成功消融显性旁路对房颤（AF）发生率的影响，其中75例有既往记录的房颤，54例无既往记录的房颤。14例曾发生心室颤动。研究了预测复发的因素，包括电生理参数。心房易损性定义为在两个基础起搏周期长度下，先用单个、然后用双个心房期外刺激诱发持续房颤（大于1分钟）。与仅有折返性心动过速的患者相比，临床房颤患者男性更多（77%对54%，p = 0.008）且年龄更大（35±12岁对29±12岁，p = 0.01）。他们导致顺行性旁路阻滞的周期长度显著更短（252±42毫秒对298±83毫秒，p<0.001），心房易损性发生率更高（89%对24%，p<0.001），随后需要心脏复律的发生率也更高（51%对15%，p<0.001）。出院后，随访期为35±12个月（范围18至76个月）；7例既往有自发性房颤的患者（9%）在消融后平均10个月复发。年龄、结构性心脏病的存在、旁路位置、心房不应期和旁路顺行传导参数均不能预测房颤复发。消融后心房易损性的持续存在是与房颤进一步复发相关的唯一因素。既往有房颤的患者中，仅56%在消融后观察到心房易损性，而消融前为89%。结论是，成功的导管消融旁路可防止91%的患者房颤进一步复发。（摘要截短于250字）
