Department of Cardiology, St-Jan Hospital Bruges, Bruges, Belgium.
J Cardiovasc Electrophysiol. 2010 Apr;21(4):381-8. doi: 10.1111/j.1540-8167.2009.01646.x. Epub 2009 Nov 12.
To identify procedural parameters predicting recurrence of atrial fibrillation (AF) after a first circumferential pulmonary vein isolation (CPVI).
One hundred seventy-one patients undergoing CARTO-guided CPVI for recurrent AF with a left atrial (LA) diameter <45 mm were studied. Follow-up (symptoms and 7-day Holter) was performed at 1 and 3 months and every 3 months thereafter. Clinical and procedural characteristics between successful patients and patients undergoing repeat ablation were compared. In addition, procedural parameters of the first procedure were compared with parameters during repeat ablation.
After first CPVI, 80% of patients were free of AF without antiarrhythmic drugs after a follow-up (FU) of 28 +/- 11 months (N = 136). Thirty-five patients (20%) had recurrence of AF of which 25 underwent repeat ablation (N = 25). Clinical characteristics did not differ between the successful and repeat group. A triggering vein during the index procedure was significantly more observed in the repeat group (56% vs 11%, P < 0.001). At repeat ablation, 2.6 +/- 1.2 veins per patient were reconnected. Whereas there was no preferential reconnecting PV, all PVs triggering at index were reconnected (100%).
(1) In patients with symptomatic recurrent AF, the presence of a triggering pulmonary vein during ablation is a paradoxical predictor for AF recurrence after PV isolation. (2) The consistent finding of reconnection of the triggering PV at repeat ablation, suggests that, in these patients, the triggering PV is the culprit vein and that reconnection invariably results in clinical AF recurrence. (3) The present study advocates a strategy of even more stringent PV isolation in case of a triggering PV.
确定预测首次环形肺静脉隔离（CPVI）后心房颤动（AF）复发的程序参数。
研究了 171 例接受 CARTO 引导的 CPVI 治疗左心房（LA）直径<45mm 的复发性 AF 患者。在 1 个月和 3 个月后以及此后每 3 个月进行随访（症状和 7 天 Holter）。比较成功患者和再次消融患者的临床和程序特征。此外，还比较了首次手术的程序参数与再次消融期间的参数。
在首次 CPVI 后，80%的患者在 28±11 个月的随访（N=136）中无需抗心律失常药物即可无 AF。35 例（20%）出现 AF 复发，其中 25 例接受再次消融（N=25）。成功组和重复组的临床特征无差异。在指数手术中有触发静脉的患者在重复组中明显更多（56%对 11%，P<0.001）。在重复消融时，每个患者重新连接 2.6±1.2 条静脉。尽管没有优先重新连接 PV，但在指数时触发的所有 PV 均重新连接（100%）。
（1）在有症状的复发性 AF 患者中，消融过程中存在触发肺静脉是 PV 隔离后 AF 复发的矛盾预测因子。（2）在重复消融时发现触发 PV 的一致重新连接，表明在这些患者中，触发 PV 是罪魁祸首静脉，重新连接总是导致临床 AF 复发。（3）本研究主张在存在触发 PV 的情况下采取更严格的 PV 隔离策略。
