Korea University Cardiovascular Center, Seoul, Korea.
Korean Circ J. 2010 May;40(5):235-8. doi: 10.4070/kcj.2010.40.5.235. Epub 2010 May 27.
During the index procedure of catheter ablation (CA) for atrial fibrillation (AF), it is important to assess whether other atrial or ventricular tachyarrhythmia coexist. Their symptoms are often attributed to residual tachycardia after successful elimination of AF by CA. This tachycardia could also be non-pulmonary vein (PV) foci initiated AF. This study examined the coexistence of other sustained tachyarrhythmia of patients who underwent radiofrequency CA (RFCA) for AF.
Four hundred fifty-nine consecutive patients (375 males, aged 53.4+/-11.4 years) who underwent RFCA for AF were investigated. Atrial and ventricular programmed stimulation (PS) with or without isoproterenol infusion were performed, and spontaneously developed tachycardias were analyzed.
Fifteen patients (3.3% of total) were diagnosed to have other sustained arrhythmias that included slow-fast type atrioventricular nodal reentrant tachycardia (AVNRT, n=6), atrioventricular reentrant tachycardia (AVRT, n=5) that utilized left posteroseptal (n=4) and parahisian bypass tract (n=1), atrial tachycardia (AT, n=2) originating from the foramen ovale (n=1) and the ostium of coronary sinus (n=1), sustained ventricular tachycardia (VT, n=2) involving one from the apical posterolateral wall of left ventricule in a normal heart and one from an anterolateral wall in an underlying myocardial infarction (MI). These sustained tachycardias were neither clinically documented nor had structural heart diseases, with the exception of one patient with MI associated VT. Two patients had the triple tachycardia; one involved AVNRT, AVRT, and AF, and the other involved VT, AT, and AF. All associated tachycardias were successfully eliminated by RFCA.
Fifteen (3.3%) patients with AF had coexisting sustained tachycardia. RFCA was successful in these patients. Identification of tachycardia by PS before RFCA for AF should be done to maximize the efficacy of the first ablation session.
在心房颤动（AF）的导管消融（CA）索引程序中，评估是否同时存在其他房性或室性快速性心律失常非常重要。这些症状通常归因于 CA 成功消除 AF 后残留的心动过速。这种心动过速也可能是由非肺静脉（PV）灶引发的 AF。本研究检查了接受射频 CA（RFCA）治疗 AF 的患者是否存在其他持续性快速性心律失常。
共调查了 459 例连续接受 RFCA 治疗 AF 的患者（375 例男性，年龄 53.4+/-11.4 岁）。进行心房和心室程控刺激（PS），并进行异丙肾上腺素输注，分析自发出现的心动过速。
15 例患者（总患者的 3.3%）被诊断为存在其他持续性心律失常，包括快慢型房室结折返性心动过速（AVNRT，n=6）、房室折返性心动过速（AVRT，n=5），其中 4 例采用左后间隔和 1 例旁路旁道，房性心动过速（AT，n=2）起源于卵圆孔（n=1）和冠状窦口（n=1），持续性室性心动过速（VT，n=2）涉及左心室心尖后外侧壁的 1 例和心肌梗死（MI）的前外侧壁的 1 例。这些持续性心动过速均无临床记录，也无结构性心脏病，除了 1 例伴有 MI 的 VT 患者。2 例患者同时出现三种心动过速；一种涉及 AVNRT、AVRT 和 AF，另一种涉及 VT、AT 和 AF。所有相关的心动过速均通过 RFCA 成功消除。
15 例（3.3%）AF 患者伴有共存的持续性心动过速。这些患者的 RFCA 治疗均获得成功。在 RFCA 治疗 AF 之前通过 PS 识别心动过速，应能最大限度地提高首次消融治疗的疗效。
