Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
J Cardiovasc Electrophysiol. 2011 Apr;22(4):385-93. doi: 10.1111/j.1540-8167.2010.01927.x. Epub 2010 Oct 13.
Multiple remodeling patterns have been observed after catheter ablation of atrial fibrillation (AF).
We aimed to clarify the electrical/structural properties associated with recurrences after ablation of chronic AF.
After a stepwise ablation procedure in 120 consecutive patients with persistent/long-lasting persistent AF, 36 had a recurrence of AF (Group 1/Group 2: recurrence with paroxysmal/persistent AF, n = 16/20).
During the first procedure, the left atrial (LA) bipolar voltage did not differ between the 2 groups, and the LA volume was smaller in Group 1 than in Group 2 and it was the only factor predicting the recurrent types (P = 0.009, OR = 1.04). In the second procedure, the bipolar voltage of the global left atrium increased (1.33 ± 0.11 mV vs 1.76 ± 0.16 mV, P = 0.001) in Group 1 and decreased (1.31 ± 0.14 mV vs 0.90 ± 0.12 mV, P = 0.01) in Group 2, when compared with that of the first procedure. The LA low-voltage area (<0.5 mV) decreased in Group 1, and increased in Group 2. The LA volume (90 ± 8 cm(3) vs 72 ± 8 cm(3), P = 0.002) decreased in the second procedure in Group 1. It remained the same in Group 2. The right atrial substrates did not change between the procedures. After a follow-up of 27 ± 3 months, all patients in Group 1 and 14 patients in Group 2 remained in sinus rhythm (P = 0.02).
A better outcome with reverse electrical and structural remodeling occurred after the ablation of chronic AF when the recurrence was paroxysmal AF. Progressive electrical remodeling without any structural remodeling developed in those with a recurrence involving persistent AF.
在心房颤动（AF）的导管消融后观察到多种重塑模式。
我们旨在阐明与消融后慢性 AF 复发相关的电/结构特性。
在 120 例持续性/长持续性 AF 患者的逐步消融程序后，36 例患者出现 AF 复发（组 1/组 2：阵发性/持续性 AF 复发，n = 16/20）。
在第一次手术中，两组之间左心房（LA）双极电压没有差异，并且组 1 的 LA 体积小于组 2，并且是预测复发性类型的唯一因素（P = 0.009，OR = 1.04）。在第二次手术中，与第一次手术相比，组 1 的全球左心房双极电压增加（1.33 ± 0.11 mV 对 1.76 ± 0.16 mV，P = 0.001），而组 2 的双极电压降低（1.31 ± 0.14 mV 对 0.90 ± 0.12 mV，P = 0.01）。组 1 的 LA 低电压区域（<0.5 mV）减少，而组 2 的 LA 低电压区域增加。在第二次手术中，组 1 的 LA 体积（90 ± 8 cm3）减少，而组 2 的 LA 体积保持不变。两次手术之间右心房基质没有变化。在 27 ± 3 个月的随访中，组 1 的所有患者和组 2 的 14 名患者均保持窦性心律（P = 0.02）。
在慢性 AF 的消融后，当复发为阵发性 AF 时，出现了更好的反向电和结构重塑结果。在那些复发涉及持续性 AF 的患者中，出现了没有任何结构重塑的进行性电重塑。
