Fiala Martin, Chovancík Jan, Nevralová Renáta, Neuwirth Radek, Jiravský Otakar, Januska Jaroslav, Branny Marian
Department of Cardiology, Heart Center, Hospital Podlesí a.s., Trinec, Czech Republic.
Pacing Clin Electrophysiol. 2008 Aug;31(8):985-97. doi: 10.1111/j.1540-8159.2008.01126.x.
Left atrial (LA) structures for the maintenance of different atrial fibrillation (AF) forms are not uniform. The incidence, electrophysiological patterns, and LA sites of sinus rhythm (SR) restoration during ablation of different AF forms were evaluated.
One hundred patients with long-lasting persistent AF were retrospectively compared to 35 patients with short-lasting persistent AF and 59 patients with a sustained episode of paroxysmal AF. All patients underwent a first ablation using a stepwise ablation approach with the endpoint of SR restoration by ablation.
SR was restored in 38%, 83%, and 97% of patients with long-lasting persistent, short-lasting persistent, and paroxysmal AF, respectively (P <0.001 for long-lasting persistent vs paroxysmal AF; P = 0.02 for long-lasting persistent vs short-lasting persistent AF). When modes and sites of SR restoration were evaluated among the patients with long-lasting persistent, short-lasting persistent, and paroxysmal AF, SR was restored via conversion into LA tachycardia in 79%, 52%, and 4% of patients (P <0.001 for long-lasting persistent vs paroxysmal AF); by the pulmonary vein encircling in 8%, 24%, and 93% patients (P <0.001 for long-lasting persistent vs paroxysmal AF); and by ablation at the LA anterior wall or inside the coronary sinus in 66%, 45%, and 2% patients (P <0.001 for long-lasting persistent and paroxysmal AF). During the 31 +/- 14 month follow-up since the first ablation, of the 50 patients with long-term SR maintenance (38 patients free of class I or III antiarrhythmic drugs), SR was restored by ablation in 29 (58%) patients versus nine (18%) patients out of 50 patients with unsuccessful clinical outcome (P = 0.009).
Ablation of long-lasting persistent AF was characterized by more frequent failure to restore SR, and predominant conversion into LA tachycardia prior to SR restoration, and SR restoration by ablation outside the LA posterior wall. SR restoration by ablation was associated with better clinical outcome in these patients.
维持不同类型心房颤动（AF）的左心房（LA）结构并不一致。本研究评估了不同类型AF消融过程中窦性心律（SR）恢复的发生率、电生理模式及LA部位。
回顾性比较100例长期持续性AF患者、35例短期持续性AF患者和59例阵发性AF持续发作患者。所有患者均采用逐步消融方法进行首次消融，消融终点为恢复SR。
长期持续性、短期持续性和阵发性AF患者中SR恢复率分别为38%、83%和97%（长期持续性AF与阵发性AF相比，P<0.001；长期持续性AF与短期持续性AF相比，P = 0.02）。在评估长期持续性、短期持续性和阵发性AF患者的SR恢复模式和部位时，79%、52%和4%的患者通过转为LA心动过速恢复SR（长期持续性AF与阵发性AF相比，P<0.001）；8%、24%和93%的患者通过肺静脉环绕恢复SR（长期持续性AF与阵发性AF相比，P<0.001）；66%、45%和2%的患者通过在LA前壁或冠状窦内消融恢复SR（长期持续性AF与阵发性AF相比，P<0.001）。在首次消融后的31±14个月随访期间，50例长期维持SR的患者（38例未使用I类或III类抗心律失常药物）中，29例（58%）患者通过消融恢复SR，而50例临床结局不佳的患者中有9例（18%）通过消融恢复SR（P = 0.009）。
长期持续性AF消融的特点是恢复SR失败更为频繁，在SR恢复前主要转为LA心动过速，且通过LA后壁以外的部位消融恢复SR。在这些患者中，通过消融恢复SR与更好的临床结局相关。
