Singh Sheldon M, D'Avila Andre, Kim Steven J, Houghtaling Christopher, Dukkipati Srinivas R, Reddy Vivek Y
Cardiac Arrhythmia Service-Mount Sinai School of Medicine, New York, NY 10029, USA.
J Cardiovasc Electrophysiol. 2010 Jun 1;21(6):608-16. doi: 10.1111/j.1540-8167.2009.01671.x. Epub 2009 Dec 21.
While able to achieve clinical success, the current step-wise approach to persistent atrial fibrillation (AF) ablation requires considerable "substrate" ablation and frequently mandates multiple procedures to address consequent atrial tachycardias (ATs). An alternative strategy minimizing the amount of ablation while maintaining clinical success would be desirable. We hypothesize that intraprocedural administration of a low-dose antiarrhythmic drug (AAD) during AF will organize areas of passive activation and not affect areas critical to AF maintenance, thereby potentially minimizing the ablation lesion set.
Eleven patients (age = 55 +/- 6 years; LA = 48 +/- 15 mm; median AF duration = 3 years) with persistent AF undergoing catheter ablation were enrolled in this exploratory prospective observational study. After pulmonary vein (PV) isolation, a mean cycle length (mCL) map was created and areas with mCL <120 ms were considered to represent complex fractionated atrial electrograms (CFAE). Ibutilide (0.25-1.0 mg) was then administered and a second mCL map created. Ablation lesions were placed at CAFE sites identified after ibutilide administration. Activation and/or entrainment mapping was employed to address ATs. The endpoint of ablation was achieving sinus rhythm. The average LA mCL increased (146 vs 165 ms, P = 0.01) and the LA CFAE surface area decreased after ibutilide administration. Additional ablation organized AF to either sinus rhythm or AT in 10/11 (91%) patients. After a median follow up of 455 days, 8 of 11 (72%) patients were free from AF. Three patients underwent a repeat ablation procedure (average 1.27 ablations/patient).
Ibutilide administration may organize atrial activity and facilitate AF termination during ablation while minimizing the ablation lesion set.
虽然目前持续性房颤（AF）消融的逐步方法能够取得临床成功，但需要进行大量的“基质”消融，并且常常需要多次手术来处理随之而来的房性心动过速（ATs）。一种在保持临床成功的同时尽量减少消融量的替代策略将是可取的。我们假设在房颤期间术中给予低剂量抗心律失常药物（AAD）将使被动激活区域有序化，并且不会影响对房颤维持至关重要的区域，从而有可能最小化消融灶集合。
11例持续性房颤患者（年龄=55±6岁；左心房[LA]=48±15mm；房颤持续时间中位数=3年）接受导管消融，纳入了这项探索性前瞻性观察研究。在肺静脉（PV）隔离后，创建了平均周期长度（mCL）图，mCL<120ms的区域被认为代表复杂碎裂心房电图（CFAE）。然后给予伊布利特（0.25 - 1.0mg）并创建第二个mCL图。在给予伊布利特后确定的CFAE部位放置消融灶。采用激动和/或拖带标测来处理ATs。消融终点为实现窦性心律。给予伊布利特后，平均左心房mCL增加（146对165ms，P = 0.01），左心房CFAE表面积减小。额外的消融使10/11（91%）的患者房颤转变为窦性心律或房性心动过速。在中位随访455天后，11例患者中有8例（72%）无房颤发作。3例患者接受了再次消融手术（平均每位患者1.27次消融）。
给予伊布利特可能使心房活动有序化，并在消融期间促进房颤终止，同时最小化消融灶集合。
