Wang Xin-hua, Shi Hai-feng, Sun Yu-min, Gu Jia-ning, Zhou Li, Liu Xu
Department of Cardiology, Shanghai Chest Hospital (affiliated to Shanghai Jiaotong University), Shanghai 200030, PR China.
Europace. 2008 Feb;10(2):197-204. doi: 10.1093/europace/eum298.
Circumferential pulmonary vein isolation (CPVI) had been proved effective for treating atrial fibrillation (AF). However, the achievement of pulmonary vein (PV) isolation was sometimes challenging. PVs could not be isolated until some key target sites (KTSs) were ablated thoroughly. The aim of our study was to explore the distribution of KTSs.
Four hundred and fifty-two cases (271 males, mean age 62.5 +/- 12.6 years) with drug-refractory AF were enrolled for catheter ablation. CARTO-guided CPVI was performed in all cases with one circular catheter for verification of PVs isolation. Target sites where PV potentials delayed, conduction sequence changed, slowed down, or isolated were defined as KTSs. From 452 CPVI procedures, 1520 KTSs were identified; 813 of which were located at left PV antrums and 707 were at right PV antrums. KTSs at left PV antrums were most commonly situated at anterior wall (63%), while KTSs at right PV antrums were most commonly situated at posterior wall (66.2%). Additional gaps ablation was performed for left PVs in 344 cases and for right PVs in 248 cases owing to incomplete PVs isolation by a single attempt of CPVI. One thousand one hundred and fifty-eight KTSs were identified, 662 of which were located at left PV antrums and 496 were at right PV antrums. At the anterior wall, 66.1% of left PV KTSs were located, and 67.9% of right PV KTSs were located at the posterior wall. Out of 1158, 961 (82.99%) KTSs were predicted correctly by circular mapping. PV isolation could not be achieved until some KTSs were ablated by higher power, longer duration, and higher irrigation rate than usual.
KTSs during CPVI were most commonly situated at the anterior wall of left PVs and at the posterior wall of right PVs. Circular mapping within ipsilateral PVs' ostia could accurately predict the location of KTSs. Some KTSs must be ablated thoroughly by applying higher power, longer duration, and higher irrigation rate than usual to achieve PV isolation.
环肺静脉隔离术（CPVI）已被证明对治疗心房颤动（AF）有效。然而，实现肺静脉（PV）隔离有时具有挑战性。在一些关键靶点（KTSs）被彻底消融之前，肺静脉无法被隔离。我们研究的目的是探索关键靶点的分布情况。
纳入452例（271例男性，平均年龄62.5±12.6岁）药物难治性房颤患者进行导管消融。所有病例均采用CARTO指导下的CPVI，使用一根环形导管来验证肺静脉隔离情况。将肺静脉电位延迟、传导顺序改变、减慢或隔离的靶点定义为关键靶点。在452例CPVI手术中，共识别出1520个关键靶点；其中813个位于左肺静脉前庭，707个位于右肺静脉前庭。左肺静脉前庭的关键靶点最常见于前壁（63%），而右肺静脉前庭的关键靶点最常见于后壁（66.2%）。由于单次CPVI尝试未能完全实现肺静脉隔离，对344例患者的左肺静脉和248例患者的右肺静脉进行了额外的间隙消融。共识别出1158个关键靶点，其中662个位于左肺静脉前庭，496个位于右肺静脉前庭。在前壁，66.1%的左肺静脉关键靶点位于此处，67.9%的右肺静脉关键靶点位于后壁。在1158个关键靶点中，961个（82.99%）通过环形标测被正确预测。在一些关键靶点被以高于常规的功率、更长的持续时间和更高的灌注速率消融之前，无法实现肺静脉隔离。
CPVI期间的关键靶点最常见于左肺静脉前壁和右肺静脉后壁。同侧肺静脉开口内的环形标测可准确预测关键靶点的位置。必须通过以高于常规的功率、更长的持续时间和更高的灌注速率彻底消融一些关键靶点，以实现肺静脉隔离。
