经导管消融阵发性心房颤动后高剂量异丙肾上腺素和快速心房起搏致不应性的临床价值。
Clinical value of noninducibility by high-dose isoproterenol versus rapid atrial pacing after catheter ablation of paroxysmal atrial fibrillation.
机构信息
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
出版信息
J Cardiovasc Electrophysiol. 2010 Jan;21(1):13-20. doi: 10.1111/j.1540-8167.2009.01571.x. Epub 2009 Aug 11.
BACKGROUND
AF can be induced by RAP or ISO in >85% of patients with PAF.
METHODS
ISO was administered in escalating doses of 5, 10, 15, and 20 microg/min in 112 patients (age = 56 +/- 13 years) with PAF before radiofrequency catheter ablation. AF was inducible in 97 of 112 patients (87%) at a mean dose of 15 +/- 5 microg/min. RAP induced AF in the remaining 14 of 15 patients. Antral pulmonary vein (PV) isolation (APVI) was followed by ablation of complex fractionated atrial electrograms (CFAEs) as necessary to terminate AF and render AF noninducible in response to ISO.
RESULTS
AF terminated during APVI in 72 of 111 patients (65%) and after APVI plus ablation of CFAEs in 11 of 111 patients (10%). In the remaining 28 patients (25%), sinus rhythm was restored by transthoracic cardioversion. RAP was performed in the last 61 consecutive patients who were rendered noninducible by ISO. RAP initiated AF in 20 of 61 patients (33%) and atrial flutter in 6 patients (10%). No additional ablation was performed if AF was induced with RAP; however, atrial flutter was targeted. At 12 +/- 5 months, 63/75 patients (84%) who were noninducible by ISO and 2 of 8 (25%) who still were reinducible by ISO were free from recurrent AF after a single ablation procedure without antiarrhythmic drugs (P = 0.001). AF recurred in 20 of 36 patients (56%) who required cardioversion for persistent AF after ablation (P < 0.001). Among the 61 patients who also underwent RAP, 12 of 20 (60%) who were, and 31 of 41 (76%) who were not inducible by RAP were free from recurrent AF (P = 0.21). The accuracy of noninducibility as a predictor of clinical outcome was 83% with ISO and 64% by RAP (P = 0.03).
CONCLUSIONS
The response to isoproterenol after catheter ablation of PAF more accurately predicts clinical outcome than the response to RAP.
背景
在患有房扑（PAF）的 >85%的患者中，RAP 或 ISO 可诱发房扑。
方法
在 112 例接受射频导管消融术的 PAF 患者中，以 5、10、15 和 20μg/min 的递增剂量给予 ISO。在 112 例患者中，97 例（87%）在平均剂量 15±5μg/min 时可诱发房扑。其余 15 例中的 14 例可由 RAP 诱发房扑。进行肺静脉（PV）隔离（APVI）后，如果需要，进行复杂碎裂心房电图（CFAE）消融，以终止房扑并使房扑在 ISO 刺激下不再可诱发。
结果
在 111 例患者中，72 例（65%）在 APVI 期间终止房扑，11 例（10%）在 APVI 加 CFAE 消融后终止房扑。在其余 28 例患者（25%）中，通过经胸心脏复律恢复窦性心律。在最后 61 例对 ISO 无反应的连续患者中进行了 RAP。RAP 在 61 例患者中的 20 例（33%）诱发房扑，6 例（10%）诱发房扑。如果 RAP 诱发房扑，则不进行额外消融；然而，如果诱发房扑，则对其进行治疗。在 12±5 个月时，63/75 例（84%）对 ISO 无反应且 2/8 例（25%）仍可由 ISO 诱发的患者在单次消融后无需抗心律失常药物即可避免复发性房扑（P=0.001）。在消融后需要心脏复律治疗持续性房扑的 36 例患者中，20 例（56%）房扑复发（P<0.001）。在还接受了 RAP 的 61 例患者中，RAP 可诱发房扑的 20 例（60%）和不能诱发房扑的 41 例（76%）中，分别有 12 例（60%）和 31 例（76%）无复发性房扑（P=0.21）。ISO 作为预测临床结果的指标，其无反应的准确率为 83%，而 RAP 为 64%（P=0.03）。
结论
与 RAP 相比，房扑消融后异丙肾上腺素的反应更能准确预测临床结果。
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