持续性心房颤动导管消融后主导频率的急剧下降与临床转归。
A critical decrease in dominant frequency and clinical outcome after catheter ablation of persistent atrial fibrillation.
机构信息
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
出版信息
Heart Rhythm. 2010 Mar;7(3):295-302. doi: 10.1016/j.hrthm.2009.11.024. Epub 2009 Dec 2.
BACKGROUND
Termination of persistent atrial fibrillation (AF) by radiofrequency ablation (RFA) is associated with a high probability of freedom from AF but requires extensive ablation and long procedure times.
OBJECTIVE
The purpose of this study was to determine whether a critical decrease in the dominant frequency (DF) of AF is a sufficient endpoint for RFA of persistent AF.
METHODS
Antral pulmonary vein isolation (APVI) followed by RFA of complex fractionated atrial electrograms (CFAEs) in the atria and coronary sinus was performed in 100 consecutive patients with persistent AF. The DF of AF in lead V1 and in the coronary sinus was determined by fast Fourier transform (FFT) analysis at baseline and before termination of AF to identify a critical decrease in DF predictive of sinus rhythm after RFA.
RESULTS
A > or =11% decrease in DF had the highest accuracy in predicting freedom from atrial arrhythmias, with a sensitivity of 0.71 and a specificity of 0.82 (P <.001). At a mean follow-up of 14 +/- 3 months after one ablation procedure, sinus rhythm was maintained off antiarrhythmic drugs in 8/35 (23%) and 20/26 (77%) of patients with a <11% and > or =11% decrease in DF, respectively (P <.001). Sinus rhythm was maintained in 24/39 patients (62%) in whom RFA terminated AF. The duration of RFA and total procedure time were longer in patients with AF termination (95 +/- 23 and 358 +/- 87 minutes) than in patients with a <11% decrease in the DF (77 +/- 16 and 293 +/- 70 minutes) or > or =11% decrease in DF (80 +/- 17 and 289 +/- 73 minutes), respectively (P <.01). Among the variables of age, gender, left atrial diameter, duration of AF, left ventricular ejection fraction, duration of RFA, a > or =11% decrease in DF, and termination of AF, a > or =11% decrease in DF (odds ratio = 9.89, 95% confidence interval [CI] 2.84-34.47) and termination during RFA (OR = 4.38, 95% CI 1.50-12.80) were the only independent predictors of freedom from recurrent atrial arrhythmias.
CONCLUSION
In a retrospective analysis of consecutive patients with persistent AF, a decrease in the DF of AF by 11% in response to APVI and ablation of CFAEs was associated with a probability of maintaining sinus rhythm that was similar to that when RFA terminates AF.
背景
射频消融（RFA）终止持续性心房颤动（AF）与 AF 无复发的可能性高度相关，但需要广泛的消融和较长的手术时间。
目的
本研究旨在确定 AF 的主导频率（DF）是否显著降低是否足以作为持续性 AF 的 RFA 终点。
方法
对 100 例持续性 AF 患者进行肺静脉前庭隔离（APVI），然后对心房和冠状窦内的复杂碎裂心房电波（CFAE）进行 RFA。通过快速傅立叶变换（FFT）分析在基线和 AF 终止前在 V1 导联和冠状窦中确定 AF 的 DF，以确定对 RFA 后窦性节律有预测价值的 DF 临界降低。
结果
DF 降低≥11%的患者在预测无房性心律失常方面具有最高的准确性，其敏感性为 0.71，特异性为 0.82（P<0.001）。在一次消融术后平均 14±3 个月的随访中，DF 降低<11%和≥11%的患者分别有 8/35（23%）和 20/26（77%）例（P<0.001）在没有抗心律失常药物的情况下维持窦性节律。在 RFA 终止 AF 的 39 例患者中，有 24 例（62%）维持窦性节律。与 DF 降低<11%的患者（95±23 分钟和 358±87 分钟）和 DF 降低≥11%的患者（95±23 分钟和 358±87 分钟）相比，RFA 终止 AF 的患者 RFA 时间和总手术时间更长（分别为 95±23 分钟和 358±87 分钟和 80±17 分钟和 289±73 分钟）（P<0.01）。在年龄、性别、左心房直径、AF 持续时间、左心室射血分数、RFA 持续时间、DF 降低≥11%和 AF 终止等变量中，DF 降低≥11%（比值比=9.89，95%置信区间[CI]2.84-34.47）和 RFA 期间终止（OR=4.38，95%CI1.50-12.80）是无复发性房性心律失常的唯一独立预测因素。
结论
在对连续的持续性 AF 患者进行的回顾性分析中，APVI 和 CFAE 消融后 AF 的 DF 降低 11%与维持窦性节律的可能性相关，与 RFA 终止 AF 时相似。
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