Clinical Electrophysiology Laboratory and Arrhythmia Center, Fu Wai Hospital and Cardiovascular Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Heart Rhythm. 2011 Apr;8(4):489-92. doi: 10.1016/j.hrthm.2010.11.036. Epub 2010 Nov 23.
While inducibility of atrial fibrillation (AF) is often used as an endpoint for radiofrequency ablation of AF, little is known regarding inducibility among normals. We therefore evaluated the inducibility of AF with rapid atrial pacing in patients without a clinical history of AF after catheter ablation of supraventricular tachycardia (SVT).
We prospectively evaluated 86 patients with no history of AF who were referred for catheter ablation of SVT. After successful ablation, two different rapid atrial pacing protocols for induction of AF were tested. First, AF induction was attempted by 5-second bursts of atrial pacing from the coronary sinus ostium (CSO) at three different cycle lengths (CLs). Next, decremental pacing was performed from the CSO starting at a CL of 250 ms to the loss of 1:1 atrial capture. This protocol was repeated 3 times for each subject.
Three of the subjects (3.5%) enrolled had inducible AF with the first pacing protocol. However, with the second protocol, AF was inducible in 22 patients (25.6%), including sustained AF in 16 patients (18.6%). There were significant differences in the inducibility of AF between the two atrial pacing protocols. Additionally, with the second pacing protocol, patients with a loss of 1:1 atrial capture at CL <180 ms were more easily inducible for AF (21/63 vs. 1/23; P = .006).
Using a specific, decremental pacing protocol, 26% of patients without a history of AF had inducible AF. These findings suggest that significant further investigation is needed to optimize the specificity of using AF induction as an endpoint for AF ablation.
尽管心房颤动（AF）的可诱导性通常被用作射频消融治疗 AF 的终点，但对于正常人群中的可诱导性知之甚少。因此，我们评估了在导管消融治疗室上性心动过速（SVT）后无 AF 临床病史的患者中，使用快速心房起搏诱导 AF 的可诱导性。
我们前瞻性评估了 86 例无 AF 病史且因 SVT 行导管消融的患者。消融成功后，测试了两种不同的快速心房起搏方案以诱导 AF。首先，通过从冠状窦口（CSO）进行 5 秒的心房起搏脉冲，以三种不同的心动周期长度（CL）尝试诱导 AF。接下来，从 CSO 开始进行递减起搏，起始 CL 为 250 ms，直到失去 1:1 心房捕获。每个患者重复此方案 3 次。
3 名受试者（3.5%）采用第一种起搏方案可诱发出 AF。然而，采用第二种方案，22 名患者（25.6%）可诱发出 AF，包括 16 名患者（18.6%）发生持续性 AF。两种心房起搏方案的 AF 可诱导性存在显著差异。此外，采用第二种起搏方案时，CL <180 ms 时失去 1:1 心房捕获的患者更易诱发出 AF（21/63 比 1/23；P =.006）。
使用特定的递减起搏方案，26%无 AF 病史的患者可诱发出 AF。这些发现表明，需要进一步深入研究，以优化将 AF 诱导作为 AF 消融终点的特异性。
