Ninomiya Yuichi, Iriki Yasuhisa, Ishida Sanemasa, Oketani Naoya, Matsushita Takehiko, Ichiki Hitoshi, Okui Hideki, Kataoka Tetsuro, Yoshikawa Akiko, Ogawa Masakazu, Saihara Keishi, Shinsato Takuro, Miyata Masaaki, Hamasaki Shuichi, Tei Chuwa
Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Pacing Clin Electrophysiol. 2009 Oct;32(10):1307-12. doi: 10.1111/j.1540-8159.2009.02478.x.
Although reconduction after pulmonary vein (PV) isolation is considered to play a key role in the recurrence of paroxysmal atrial fibrillation (AF), there have been few reports regarding the precise time course of early reconduction. Several studies have suggested that transient PV reconduction facilitated by adenosine may predict long-term AF recurrence. This study was designed to clarify the incidence and time course of early reconduction after PVI during the procedure and to confirm whether the use of ATP after a certain observation period was useful to detect early reconduction after PVI.
In 21 patients (18 males, 56 +/- 11 years) with drug refractory AF, radiofrequency circumferential PV antrum ablation was performed in all 4 PVs. After the completion of isolation, electrograms in each PV were repeatedly recorded (1.98 +/- 0.57 times per PV) using a circular mapping catheter for an observation period of 87 +/- 29 minutes. After isolation of all 4 PVs, 30 mg of adenosine triphosphate (ATP) was administered during isoproterenol infusion.
PV electrical isolation was initially achieved in all 81 PVs. During the observation period, 12 (15%) PVs in 10 (48%) of 21 patients exhibited spontaneous reconduction. Among the remaining 69 PVs, 8 (12%) additional PVs had reconduction with the use of ATP. All PV reconduction was successfully eliminated by 4.5 +/- 2.2 additional radiofrequency applications.
A sufficient observation period and the use of ATP are useful to detect early reconduction after PV isolation.
尽管肺静脉（PV）隔离术后的再传导被认为在阵发性心房颤动（AF）复发中起关键作用，但关于早期再传导的确切时间进程的报道很少。几项研究表明，腺苷促进的短暂PV再传导可能预测AF的长期复发。本研究旨在阐明术中PV隔离术后早期再传导的发生率和时间进程，并确认在一定观察期后使用三磷酸腺苷（ATP）是否有助于检测PV隔离术后的早期再传导。
对21例（18例男性，年龄56±11岁）药物难治性AF患者的所有4条PV进行环肺静脉前庭射频消融。隔离完成后，使用环状标测导管在87±29分钟的观察期内反复记录每个PV的电图（每个PV 1.98±0.57次）。在所有4条PV隔离后，在输注异丙肾上腺素期间给予30mg三磷酸腺苷（ATP）。
最初在所有81条PV中均实现了PV电隔离。在观察期内，21例患者中有10例（48%）的12条（15%）PV出现自发再传导。在其余69条PV中，另外8条（12%）PV在使用ATP后出现再传导。通过额外4.5±2.2次射频应用成功消除了所有PV再传导。
足够的观察期和ATP的使用有助于检测PV隔离术后的早期再传导。
