Chang Shih-Lin, Tai Ching-Tai, Lin Yenn-Jiang, Wongcharoen Wanwarang, Lo Li-Wei, Tuan Ta-Chuan, Udyavar Ameya R, Chang Sheng-Hsiung, Tsao Hsuan-Ming, Hsieh Ming-Hsiung, Hu Yu-Feng, Chen Yi-Jen, Chen Shih-Ann
Division of Cardiology and Cardiovascular Research Center, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taipei, Taiwan.
J Cardiovasc Electrophysiol. 2007 Jun;18(6):607-11. doi: 10.1111/j.1540-8167.2007.00823.x. Epub 2007 May 3.
Some conflicting results of the efficacy of the inducibility test used in the catheter ablation of atrial fibrillation (AF) have been reported. The aim of this study was to investigate the inducibility and efficacy of circumferential ablation with pulmonary vein isolation (PVI) in patients with paroxysmal AF and its relationship to the atrial substrate.
This study consisted of 88 patients with paroxysmal AF who underwent catheter ablation. Electroanatomic mapping using a NavX system was performed and the biatrial voltage was obtained during sinus rhythm. After successful circumferential ablation with PVI, an inducibility test was performed to determine the requirement for creating left atrial (LA) ablation line. After procedure, patients with inducible AF had a higher recurrence rate than did those with noninducibility of AF (55% vs 18%, P = 0.02). The patients with inducible AF after the PVI had a lower biatrial voltage than did those with negative inducibility. The patients with inducible AF after the final procedure who had a recurrence had a lower LA voltage (1.3 +/- 0.4 vs 1.8 +/- 0.4 mV, P = 0.02) and longer LA total activation time (99 +/- 18 vs 88 +/- 13 msec, P = 0.02) than did those with noninducible AF and no recurrence. None of the patients had occurrence of LA flutter during the follow-up.
After a single procedure of circumferential ablation with PVI and noninducibility, 82% patients did not have recurrence of AF. The inducibility of AF was related to the recurrence of AF. The atrial substrate affected the outcome of the inducibility.
关于心房颤动（AF）导管消融术中使用的诱发试验的疗效，已有一些相互矛盾的结果报道。本研究的目的是探讨阵发性AF患者行肺静脉隔离（PVI）环周消融的诱发情况及疗效，以及其与心房基质的关系。
本研究纳入88例行导管消融的阵发性AF患者。使用NavX系统进行电解剖标测，并在窦性心律时获取双房电压。成功完成PVI环周消融后，进行诱发试验以确定是否需要创建左心房（LA）消融线。术后，AF可诱发的患者复发率高于AF不可诱发的患者（55%对18%，P = 0.02）。PVI后AF可诱发的患者双房电压低于AF不可诱发的患者。最终术后AF可诱发且复发的患者，其LA电压（1.3±0.4对1.8±0.4 mV，P = 0.02）低于AF不可诱发且未复发的患者，LA总激动时间更长（99±18对88±13毫秒，P = 0.02）。随访期间无一例患者发生LA扑动。
单次行PVI环周消融且AF不可诱发后，82%的患者未出现AF复发。AF的可诱发性与AF复发有关。心房基质影响诱发试验的结果。
