Pokushalov Evgeny, Romanov Alexander, Artyomenko Sergey, Turov Alex, Shirokova Natalya, Katritsis Demosthenes G
Arrhythmia Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Pacing Clin Electrophysiol. 2010 Oct;33(10):1231-8. doi: 10.1111/j.1540-8159.2010.02800.x.
Modification of left atrial ganglionated plexi (GP) is a promising technique for the treatment of paroxysmal atrial fibrillation (AF) but its therapeutic efficacy is not established. This study aimed at evaluating the effectiveness of anatomic GP modification by means of an implantable arrhythmia monitoring device.
In 56 patients with paroxysmal AF, radiofrequency ablation at anatomic sites, where the main clusters of GP have been identified in the left atrium, was performed. In all patients, an electrocardiogram monitor (Reveal XT, Medtronic Inc., Minneapolis, MN, USA) was implanted before (n = 7) or immediately after (n = 49) AF ablation.
Average duration of the procedure was 142 ± 18 min and average fluoroscopy time 20 ± 7 min. In total, 53-81 applications of RF energy were delivered (mean of 18.2 ± 3.8 at each of the four areas of GP ablation). Heart rate variability was assessed in 31 patients. Standard deviation of RR intervals over the entire analyzed period, the root mean square of differences between successive RR intervals, and high frequencies decreased, while HRmin, HRmean, and LF to HF ratio increased immediately postablation; these values returned to baseline 6 months after the procedure. At end of 12-month follow-up, 40 (71%) patients were free of arrhythmia recurrence. Ten patients had AF recurrence, two patients had left atrial flutter, and four patients had episodes of flutter as well as AF recurrence. Duration of episodes of AF after ablation gradually decreased over the follow-up period.
Regional ablation at the anatomic sites of the left atrial GP can be safely performed and enables maintenance of sinus rhythm in 71% of patients with paroxysmal AF for a 12-month period.
左心房神经节丛（GP）消融是一种有前景的阵发性心房颤动（AF）治疗技术，但其治疗效果尚未确定。本研究旨在通过植入式心律失常监测装置评估解剖学GP消融的有效性。
对56例阵发性AF患者，在已确定左心房中主要GP簇的解剖部位进行射频消融。所有患者在AF消融前（n = 7）或消融后立即（n = 49）植入心电图监测器（Reveal XT，美敦力公司，明尼阿波利斯，明尼苏达州，美国）。
手术平均持续时间为142±18分钟，平均透视时间为20±7分钟。总共进行了53 - 81次射频能量施加（在GP消融的四个区域中每个区域平均为18.2±3.8次）。对31例患者进行了心率变异性评估。在整个分析期间，RR间期标准差、连续RR间期差值的均方根以及高频成分降低，而最低心率、平均心率和低频与高频比值在消融后立即升高；这些值在术后6个月恢复到基线水平。在12个月随访结束时，40例（71%）患者无心律失常复发。10例患者发生AF复发，2例患者发生左心房扑动，4例患者既有扑动发作又有AF复发。消融后AF发作的持续时间在随访期间逐渐缩短。
在左心房GP的解剖部位进行区域消融可以安全地进行，并且能够使71%的阵发性AF患者在12个月内维持窦性心律。
