Katritsis Demosthenes, Giazitzoglou Eleftherios, Sougiannis Demetrios, Goumas Nicolaos, Paxinos George, Camm A John
Department of Cardiology, Athens Euroclinic, Athens, Greece.
Am J Cardiol. 2008 Aug 1;102(3):330-4. doi: 10.1016/j.amjcard.2008.03.062. Epub 2008 May 22.
There is evidence that parasympathetic denervation may prevent atrial fibrillation (AF) recurrences. This study aimed at applying an anatomic approach for ablation of atrial ganglionic plexi (GPs) in patients with paroxysmal AF. Nineteen patients with symptomatic, paroxysmal AF underwent anatomically guided radiofrequency ablation at the location of the 4 main left atrial GPs and were prospectively assessed for recurrence of AF or other atrial arrhythmia. This group was compared with 19 age- and gender-matched patients who previously underwent conventional circumferential pulmonary vein ablation. All ablation procedures were uneventful. Circumferential and GP ablations were accomplished with a radiofrequency delivery time of 28 +/- 5 versus 18 +/- 3 min (p <0.001) and a fluoroscopy time of 31 +/- 5 versus 18 +/- 5 min (p <0.001), respectively. Parasympathetic reflexes during radiofrequency ablation were elicited in 4 patients (21%). Arrhythmia recurred in 7 patients (37%) with circumferential ablation and 14 patients (74%) with GP ablation, during 1-year follow-up (p for log-rank test = 0.017). In 2 patients with GP ablation, left atrial flutters were documented in addition to AF during follow-up. Patients who underwent GP ablation had an almost 2.5 times higher risk of AF recurrence compared with those who underwent circumferential ablation (hazard ratio 2.6, 95% confidence interval 1.0 to 6.6, p = 0.038). In conclusion, anatomically guided GP ablation is feasible and safe in the electrophysiology laboratory, but this approach yields inferior clinical results compared with circumferential ablation.
有证据表明，副交感神经去神经支配可能预防心房颤动（AF）复发。本研究旨在对阵发性AF患者应用解剖学方法消融心房神经节丛（GPs）。19例有症状的阵发性AF患者在4个主要左心房GPs的位置接受了解剖学引导下的射频消融，并对AF或其他房性心律失常的复发进行了前瞻性评估。将该组患者与19例年龄和性别匹配、先前接受过传统环肺静脉消融的患者进行比较。所有消融手术均顺利完成。环肺静脉消融和GPs消融的射频发放时间分别为28±5分钟和18±3分钟（p<0.001），透视时间分别为31±5分钟和18±5分钟（p<0.001）。4例患者（21%）在射频消融过程中出现了副交感神经反射。在1年的随访中，环肺静脉消融组有7例患者（37%）出现心律失常复发，GPs消融组有14例患者（74%）出现心律失常复发（对数秩检验p=0.017）。在2例接受GPs消融的患者中，随访期间除AF外还记录到了左房扑动。与接受环肺静脉消融的患者相比，接受GPs消融的患者AF复发风险几乎高出2.5倍（风险比2.6，95%置信区间1.0至6.6，p=0.038）。总之，解剖学引导下的GPs消融在电生理实验室是可行且安全的，但与环肺静脉消融相比，这种方法的临床效果较差。
