Peters Dana C, Wylie John V, Hauser Thomas H, Nezafat Reza, Han Yuchi, Woo Jeong Joo, Taclas Jason, Kissinger Kraig V, Goddu Beth, Josephson Mark E, Manning Warren J
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
JACC Cardiovasc Imaging. 2009 Mar;2(3):308-16. doi: 10.1016/j.jcmg.2008.10.016.
We sought to evaluate radiofrequency (RF) ablation lesions in atrial fibrillation (AF) patients using cardiac magnetic resonance (CMR), and to correlate the ablation patterns with treatment success.
RF ablation procedures for treatment of AF result in localized scar that is detected by late gadolinium enhancement (LGE) CMR. We hypothesized that the extent of scar in the left atrium and pulmonary veins (PV) would correlate with moderate-term procedural success.
Thirty-five patients with AF, undergoing their first RF ablation procedure, were studied. The RF ablation procedure was performed to achieve bidirectional conduction block around each PV ostium. AF recurrence was documented using a 7-day event monitor at multiple intervals during the first year. High spatial resolution 3-dimensional LGE CMR was performed 46 +/- 28 days after RF ablation. The extent of scarring around the ostia of each PV was quantitatively (volume of scar) and qualitatively (1: minimal, 3: extensive and circumferential) assessed.
Thirteen (37%) patients had recurrent AF during the 6.7 +/- 3.6-month observation period. Paroxysmal AF was a strong predictor of nonrecurrent AF (15% with recurrence vs. 68% without, p = 0.002). Qualitatively, patients without recurrence had more completely circumferentially scarred veins (55% vs. 35% of veins, p = NS). Patients without recurrence more frequently had scar in the inferior portion of the right inferior pulmonary vein (RIPV) (82% vs. 31%, p = 0.025, Bonferroni corrected). The volume of scar in the RIPV was quantitatively greater in patients without AF recurrence (p < or = 0.05) and was a univariate predictor of recurrence using Cox regression (p = 0.049, Bonferroni corrected).
Among patients undergoing PV isolation, AF recurrence during the first year is associated with a lesser degree of PV and left atrial scarring on 3-dimensional LGE CMR. This finding was significant for RIPV scar and may have implications for the procedural technique used in PV isolation.
我们试图利用心脏磁共振成像（CMR）评估心房颤动（AF）患者的射频（RF）消融损伤，并将消融模式与治疗成功率相关联。
用于治疗AF的RF消融手术会导致局部瘢痕形成，可通过延迟钆增强（LGE）CMR检测到。我们假设左心房和肺静脉（PV）的瘢痕范围与中期手术成功率相关。
对35例首次接受RF消融手术的AF患者进行研究。进行RF消融手术以实现每个PV口周围的双向传导阻滞。在第一年的多个时间段使用7天事件监测仪记录AF复发情况。在RF消融术后46±28天进行高空间分辨率三维LGE CMR检查。对每个PV口周围的瘢痕程度进行定量（瘢痕体积）和定性（1：最小，3：广泛且呈环形）评估。
在6.7±3.6个月的观察期内，13例（37%）患者出现AF复发。阵发性AF是无AF复发的有力预测指标（复发率为15%，未复发率为68%，p = 0.002）。定性分析显示，无复发的患者静脉周围瘢痕更完全呈环形（静脉比例分别为55%和35%，p = 无显著性差异）。无复发的患者更频繁地在右下肺静脉（RIPV）下部出现瘢痕（82%比31%，p = 0.025，经Bonferroni校正）。无AF复发患者的RIPV瘢痕体积在定量上更大（p≤0.05），并且使用Cox回归分析是复发的单变量预测指标（p = 0.049，经Bonferroni校正）。
在接受PV隔离的患者中，第一年AF复发与三维LGE CMR上PV和左心房瘢痕程度较轻相关。这一发现对RIPV瘢痕具有重要意义，可能对PV隔离中使用的手术技术有影响。
