University of Lexington, Lexington, Kentucky, USA.
Heart Rhythm. 2010 Sep;7(9):1216-23. doi: 10.1016/j.hrthm.2010.01.038. Epub 2010 Feb 1.
Ablation of long-standing persistent atrial fibrillation (AF) remains challenging, with a lower success rate than paroxysmal AF. A reliable ablation endpoint has not been demonstrated yet, although AF termination during ablation may be associated with higher long-term maintenance of sinus rhythm (SR).
The purpose of this study was to determine whether the method of AF termination during ablation predicts mode of recurrence or long-term outcome.
Three hundred six patients with long-standing persistent AF, free of antiarrhythmic drugs (AADs), undergoing a first radiofrequency ablation (pulmonary vein [PV] antrum isolation and complex fractionated atrial electrograms) were prospectively included. Organized atrial tachyarrhythmias (AT) that occurred during AF ablation were targeted. AF termination mode during ablation was studied in relation to other variables (characteristics of arrhythmia recurrence, redo procedures, the use of adenosine/isoproterenol for redo, and comparison of focal versus macroreentrant ATs). Long-term maintenance of SR was assessed during the follow-up.
During AF ablation, six of 306 patients converted directly to SR, 172 patients organized into AT (with 38 of them converting in SR with further ablation), and 128 did not organize or terminate and were cardioverted. Two hundred eleven of 306 patients (69%) maintained in long-term SR without AADs after a mean follow-up of 25 +/- 6.9 months, with no statistical difference between the various AF termination modes during ablation. Presence or absence of organization during ablation clearly predicted the predominant mode of recurrence, respectively, AT or AF (P = .022). Among the 74 redo ablation patients, 24 patients (32%) had extra PV triggers revealed by adenosine/isoproterenol. Termination of focal ATs was correlated with higher long-term success rate (24/29, 83%) than termination of macroreentrant ATs (20/35, 57%; P = .026).
AF termination during ablation (conversion to AT or SR) could predict the mode of arrhythmia recurrence (AT vs. AF) but did not impact the long-term SR maintenance after one or two procedures. AT termination with further ablation did not correlate with better long-term outcome, except with focal ATs, for which termination seems critical.
消融长期持续性心房颤动（房颤）仍然具有挑战性，成功率低于阵发性房颤。尽管消融期间房颤终止可能与窦性节律（SR）的长期维持更高相关，但尚未证明可靠的消融终点。
本研究旨在确定消融期间房颤终止的方法是否预测复发模式或长期结果。
前瞻性纳入 306 例无抗心律失常药物（AAD）的长期持续性房颤患者，行首次射频消融（肺静脉[PV]窦房结隔离和复杂碎裂心房电图）。靶向消融期间发生的有组织的房性心动过速（AT）。研究了消融期间房颤终止的模式与其他变量（心律失常复发的特征、再次手术、再次手术时使用腺苷/异丙肾上腺素、局灶性与大折返性 AT 的比较）之间的关系。在随访期间评估 SR 的长期维持情况。
在房颤消融过程中，306 例患者中有 6 例直接转为 SR，172 例患者出现 AT（其中 38 例在进一步消融时转为 SR），128 例未出现或终止并进行电复律。在平均 25+/-6.9 个月的随访后，306 例患者中有 211 例（69%）在没有 AAD 的情况下长期维持 SR，消融过程中各种房颤终止模式之间无统计学差异。消融过程中的组织与否明显预测了主要的复发模式，分别为 AT 或房颤（P=0.022）。在 74 例再次消融的患者中，24 例（32%）患者通过腺苷/异丙肾上腺素显示出额外的 PV 触发。局灶性 AT 的终止与更高的长期成功率（24/29，83%）相关，而大折返性 AT 的终止（20/35，57%；P=0.026）相关。
消融期间房颤的终止（转为 AT 或 SR）可以预测心律失常复发的模式（AT 与房颤），但不会影响一两次手术后的 SR 长期维持。进一步消融终止 AT 与更好的长期结果无关，但对于局灶性 AT，终止似乎很关键。
