Verma Atul, Minor Stephen, Kilicaslan Fethi, Patel Dimpi, Hao Steven, Beheiry Salwa, Lakkireddy Dhanumjaya, Elayi S Claude, Cummings Jennifer, Martin David O, Burkhardt J David, Schweikert Robert A, Saliba Walid, Tchou Patrick J, Natale Andrea
Cleveland Clinic Foundation, Section of Electrophysiology, Cleveland, Ohio 44195, USA.
J Cardiovasc Electrophysiol. 2007 Jun;18(6):601-6. doi: 10.1111/j.1540-8167.2007.00789.x. Epub 2007 Apr 11.
Studies examining AF recurrences post-PVAI base recurrence on patient reporting of symptoms. However, whether asymptomatic recurrences are common is not well known.
To assess the incidence of atrial tachycardia/fibrillation post-PVAI as detected by a PPM and whether these recurrences correlate to symptomatic recurrence.
Eighty-six consecutive patients with symptomatic AF and PPMs with programmable mode-switch capability underwent PVAI. Mode switching was programmed post-PVAI to occur at an atrial-sensed rate of >170 bpm. Patients were followed with clinic visits, ECG, and PPM interrogation at 1, 3, 6, and 9 months post-PVAI. The number and duration of mode-switching episodes (MSEs) were recorded at each visit and is presented as median (interquartile range).
The patients (age 57 +/- 8 years, EF 54 +/- 10%) had paroxysmal (65%) and persistent (35%) AF pre-PVAI. Sensing, pacing, and lead function were normal for all PPMs at follow-up. Of the 86 patients, 20 (23%) had AF recurrence based on symptoms. All 20 of these patients had appropriate MSEs detected. Of the 66 patients without symptomatic recurrence, 21 (32%) had MSEs detected. In 19 of these patients, MSEs were few in number, compared with patients with symptomatic recurrence (16 [4-256] vs 401 [151-2,470], P < 0.01). The durations were all <60 seconds. All of these nonsustained MSEs occurred within the first 3 months post-PVAI, gradually decreasing over time. The other 2 of 21 remaining patients had numerous (1,343 [857-1,390]) and sustained (18 +/- 12 minutes) MSEs that also persisted beyond 3 months (1 beyond 6 months). Therefore, the incidence of numerous, sustained MSEs in asymptomatic patients post-PVAI was 2 of 66 (3%).
Detection of atrial tachyarrhythmias by a PPM occurred in 30% of patients without symptomatic AF recurrence. Most of these episodes were <60 seconds and waned within 3 months. Sustained, asymptomatic episodes were uncommon.
关于肺静脉隔离术（PVAI）后房颤复发的研究是基于患者症状报告来确定复发情况的。然而，无症状性复发是否常见尚不清楚。
评估通过植入式心脏起搏器（PPM）检测到的PVAI后房性心动过速/房颤的发生率，以及这些复发与症状性复发是否相关。
86例有症状性房颤且PPM具备可编程模式转换功能的连续患者接受了PVAI。PVAI后将模式转换编程为在心房感知率>170次/分时发生。在PVAI后1、3、6和9个月对患者进行门诊随访、心电图检查和PPM问询。每次随访时记录模式转换事件（MSE）的数量和持续时间，并以中位数（四分位间距）表示。
患者（年龄57±8岁，左心室射血分数54±10%）在PVAI前有阵发性房颤（65%）和持续性房颤（35%）。随访时所有PPM的感知、起搏和导线功能均正常。在86例患者中，20例（23%）基于症状出现房颤复发。所有这20例患者均检测到适当的MSE。在66例无症状复发的患者中，21例（32%）检测到MSE。在这些患者中，19例的MSE数量较少，与有症状复发的患者相比（16[4 - 256]对401[151 - 2470]，P<0.01）。持续时间均<60秒。所有这些非持续性MSE均发生在PVAI后的前3个月内，并随时间逐渐减少。其余21例患者中的另外2例有大量（1343[857 - 1390]）且持续性（18±12分钟）的MSE，且持续时间超过3个月（1例超过6个月）。因此，PVAI后无症状患者中大量、持续性MSE的发生率为66例中的2例（3%）。
在无症状性房颤复发的患者中，30%通过PPM检测到房性快速心律失常。这些发作大多数<60秒且在3个月内减弱。持续性无症状发作并不常见。
