Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
Clin Cardiol. 2010 Mar;33(3):E69-74. doi: 10.1002/clc.20567.
The purpose of this study was to investigate the relationship between the efficacy of the 2 different ablation techniques of atrial fibrillation (AF) and left atrial (LA) size.
A total of 81 patients with paroxysmal AF (n = 58) or persistent AF (n = 23) refractory to antiarrhythmic drugs underwent circumferential pulmonary vein isolation (PVI; n = 45) or PVI (n = 36) without respect to echocardiographic results for LA volume index (LAVI). Of the 81 patients, 41 had less dilated LA (group 1; LAVI < 27 cc/m(2)) and 40 had dilated LA (group 2; LAVI > or = 27 cc/m(2)). During the 9-month follow-up, 33 patients (73.3%) after circumferential PVI and 18 (50%) after PVI (P = .031) were free of arrhythmia. The risk of recurrence was associated with persistent AF, hypertension, LAVI > 27 ml/m(2), PVI, early recurrence of AF, and lower left ventricular (LV) ejection fraction (all P value <.05). In the univariate analysis of each group, PVI (hazard ratio [HR]: 2.92, 95% confidence interval [CI]: 0.12-7.08, P = .018) was associated with late recurrence only in group 2. Cox regression analysis also showed that PVI (HR: 5.6, 95% CI: 1.9-16.56, P = .002) was a significant independent predictor of recurrence only in group 2.
Circumferential PVI is more effective than PVI only in patients with a structural change of the atria, that is, a dilated LA. Our study suggests that a successful outcome in dilated LA may depend on wide modification of LA electroanatomical substrates, but wide ablation in less dilated LA may be unnecessary. Different technical strategies according to LA size are required for more a effective outcome.
本研究旨在探讨两种不同的房颤消融技术的疗效与左心房（LA）大小之间的关系。
共 81 例药物难治性阵发性房颤（n = 58）或持续性房颤（n = 23）患者接受了环形肺静脉隔离术（PVI；n = 45）或 PVI（n = 36），但不考虑左心房容积指数（LAVI）的超声心动图结果。81 例患者中，41 例 LA 扩张程度较轻（组 1；LAVI＜27 cc/m2），40 例 LA 扩张程度较重（组 2；LAVI≥27 cc/m2）。在 9 个月的随访中，环形 PVI 后 33 例（73.3%）和 PVI 后 18 例（50%）（P =.031）患者无心律失常复发。复发的风险与持续性房颤、高血压、LAVI＞27 ml/m2、PVI、房颤早期复发和较低的左心室（LV）射血分数（所有 P 值＜.05）相关。在每组的单因素分析中，PVI（风险比[HR]：2.92，95%置信区间[CI]：0.12-7.08，P =.018）仅与组 2 的晚期复发相关。Cox 回归分析也表明，PVI（HR：5.6，95%CI：1.9-16.56，P =.002）仅在组 2 中是复发的独立预测因素。
环形 PVI 比单纯 PVI 更有效，仅在心房结构改变，即 LA 扩张的患者中有效。我们的研究表明，在 LA 扩张的患者中获得成功的结果可能取决于 LA 电解剖基质的广泛改变，但在 LA 扩张程度较轻的患者中进行广泛消融可能是不必要的。根据 LA 大小采用不同的技术策略对于获得更有效的结果是必要的。
