Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
J Cardiovasc Electrophysiol. 2010 May;21(5):494-500. doi: 10.1111/j.1540-8167.2009.01667.x. Epub 2009 Dec 15.
Elimination of transient pulmonary vein recurrences (dormant PVs) induced by an ATP injection and ablation at the PV carina region is an effective strategy for atrial fibrillation (AF) ablation. The relationship between dormant PVs and the PV carina region has not been evaluated.
A total of 212 consecutive symptomatic AF patients underwent circumferential PV electrical isolation (CPVEI) with a double lasso technique. They were divided into 2 groups in a retrospective review; Group 1: those given an ATP injection during an intravenous isoproterenol infusion after the CPVEI (n = 106), and Group 2: those in which it was not given after the CPVEI (n = 106). Radiofrequency energy was applied at the earliest dormant PV activation site identified using a Lasso catheter on the CPVEI line and then PV carina region if it was ineffective.
After a successful PVEI, 54 patients (51%) in Group 1 had PV reconnections during an ATP injection. Acute PVEI sites were observed on the carina region within the CPVEI line in the right PVs (16%) and left PVs (10%). Dormant PVs were reisolated at the carina region in the right PVs (23%) and left PVs (26%). The distribution of the dormant PV sites, except for the RIPV, significantly differed from that of the acute PVEI sites (P < 0.05). Further, AF recurred significantly in the Group 2 patients as compared to those in Group 1 during 16 +/- 6.1 months of follow-up (P < 0.05).
PV carina region origins may partly be responsible for an acute PVEI and potential recurrences.
消除由 ATP 注射和消融在肺静脉嵴区域引起的短暂性肺静脉再连接（休眠 PV）是房颤（AF）消融的有效策略。休眠 PV 与肺静脉嵴区域之间的关系尚未得到评估。
共 212 例有症状的 AF 患者接受了环形肺静脉电隔离（CPVEI），采用双套索技术。回顾性研究中将他们分为 2 组；组 1：CPVEI 后静脉内异丙肾上腺素输注时给予 ATP 注射（n = 106）；组 2：CPVEI 后未给予 ATP 注射（n = 106）。如果无效，使用 Lasso 导管在 CPVEI 线上识别最早的休眠 PV 激活部位，并在该部位施加射频能量。
在成功的 PVEI 后，组 1 中有 54 例（51%）患者在 ATP 注射时出现 PV 再连接。在右肺静脉（16%）和左肺静脉（10%）的 CPVEI 线内嵴区域观察到急性 PVEI 部位。在右肺静脉（23%）和左肺静脉（26%）的嵴区域重新隔离了休眠 PV。除 RIPV 外，休眠 PV 部位的分布与急性 PVEI 部位明显不同（P < 0.05）。进一步的，与组 1 相比，组 2 的患者在 16 +/- 6.1 个月的随访中 AF 复发明显更多（P < 0.05）。
肺静脉嵴区域起源可能部分是急性 PVEI 和潜在复发的原因。
