Kumagai Koichiro, Nakashima Hideko
International University of Health and Welfare, Fukuoka, Japan.
Circ J. 2009 Feb;73(2):233-41. doi: 10.1253/circj.cj-08-0700. Epub 2008 Dec 8.
An alternative approach to complete isolation of the posterior left atrium (LA), including all pulmonary veins (PVs), for treating atrial fibrillation (AF) is the Box isolation. However, it is sometimes difficult to confirm the conduction block within the linear lesion lines, so in the present study the efficacy of the Box isolation guided by noncontact mapping (NCM) was evaluated.
A total of 188 patients, 116 with paroxysmal, 48 with persistent and 24 with longstanding persistent AF, underwent the Box isolation using NCM system. The endpoint was defined as bi-directional conduction block in the posterior LA confirmed by an activation map using NCM during pacing inside and outside of the posterior LA. The induced atrial tachyarrhythmias and non-PV foci were also ablated using NCM. After 12+/-4 months of follow-up, 91% of the patients with paroxysmal AF, 73% of those with persistent AF and 46% with longstanding persistent AF were arrhythmia-free without drugs.
NCM is useful for defining complete Box isolation and detecting the conduction gaps, localizing non-PV foci, and analyzing the mechanism of atrial tachyarrhythmias. NCM-guided Box isolation is a feasible, safe and effective method of treating AF.
用于治疗心房颤动（AF）的一种完全隔离左心房后部（LA）（包括所有肺静脉（PVs））的替代方法是“盒状隔离”。然而，有时难以确认线性病变线内的传导阻滞，因此在本研究中评估了非接触式标测（NCM）引导下的盒状隔离的疗效。
总共188例患者，其中116例为阵发性房颤，48例为持续性房颤，24例为长期持续性房颤，接受了使用NCM系统的盒状隔离。终点定义为在左心房后部内外起搏期间，通过使用NCM的激动标测证实左心房后部存在双向传导阻滞。还使用NCM消融了诱发的房性快速性心律失常和非肺静脉起源灶。经过12±4个月的随访，91%的阵发性房颤患者、73%的持续性房颤患者和46%的长期持续性房颤患者在无药物治疗的情况下无心律失常发作。
NCM有助于确定完全的盒状隔离并检测传导间隙、定位非肺静脉起源灶以及分析房性快速性心律失常的机制。NCM引导下的盒状隔离是一种治疗房颤的可行、安全且有效的方法。
