The Heart Centre, The Alfred Hospital, Melbourne 3004, Australia.
Heart. 2011 Apr;97(7):579-84. doi: 10.1136/hrt.2010.211367. Epub 2011 Feb 4.
Pulmonary vein (PV) reconnection is the Achilles heel of pulmonary vein isolation (PVI) for atrial fibrillation (AF). Dissociated pulmonary vein potentials (dPVP) may reflect abnormal PV automaticity, indicate more extensive PV muscular sleeve or may simply be an epiphenomenon.
This study sought to determine the incidence, characteristics and prognostic significance of dPVP following PVI for AF.
89 consecutive patients (mean age 58.2 ± 8.4 years, 75% male, 74% paroxysmal, 26% persistent AF) underwent antral PVI using three-dimensional mapping systems with image integration with the endpoint of bidirectional PV block. Following PV electrical isolation the presence and characteristics of dPVP were recorded. Holter monitoring was performed at 3, 6 and 12 months. Acute PV reconnection was assessed over a 30-min waiting period.
Electrical isolation was achieved in all 372 PV targeted for ablation. 69 of 372 isolated PV (19%) demonstrated dPVP after acute electrical isolation. Sites of dPVP origin were the left superior in 36%, left inferior in 20%, right superior in 31% and right inferior in 12%. All 69 dPVP demonstrated slow activity (cycle length >1500 ms) with only four persisting more than 30 min after acute isolation. There was no difference in the clinical characteristics between dPVP-positive vs dPVP-negative patients. At a mean follow-up of 21 ± 8 months the single procedure success was 25/33 (76%) in dPVP-positive versus 39/60 (64%) in dPVP-negative patients (p = -0.3). In the eight dPVP-positive patients who underwent a second procedure, 11 of the 14 (79%) veins with initial dPVP demonstrated PV-left atrial reconnection.
dPVP are present in 19% of PV following acute antral electrical isolation. The presence of dPVP did not predict recurrent AF following PVI.
肺静脉（PV）再连接是房颤（AF）肺静脉隔离（PVI）的阿喀琉斯之踵。分离的肺静脉电位（dPVP）可能反映异常的 PV 自律性，表明更广泛的 PV 肌袖或仅仅是一种偶然现象。
本研究旨在确定 PVI 治疗 AF 后 dPVP 的发生率、特征和预后意义。
89 例连续患者（平均年龄 58.2±8.4 岁，75%为男性，74%为阵发性，26%为持续性 AF）使用三维标测系统进行窦房结 PVI，图像与双向 PV 阻断的终点整合。在 PV 电隔离后，记录 dPVP 的存在和特征。进行 3、6 和 12 个月的动态心电图监测。在 30 分钟的等待期内评估急性 PV 再连接。
所有 372 个靶标 PV 均实现电隔离。在 372 个被隔离的 PV 中有 69 个（19%）在急性电隔离后显示 dPVP。dPVP 起源部位为左侧上叶 36%，左侧下叶 20%，右侧上叶 31%，右侧下叶 12%。所有 69 个 dPVP 均显示缓慢活动（周长>1500ms），仅有 4 个在急性隔离后超过 30 分钟仍持续存在。dPVP 阳性与 dPVP 阴性患者的临床特征无差异。在平均 21±8 个月的随访中，dPVP 阳性患者的单程序成功率为 25/33（76%），dPVP 阴性患者为 39/60（64%）（p=0.3）。在 8 例 dPVP 阳性患者中进行了第二次手术，14 条初始 dPVP 中有 11 条（79%）显示 PV-左心房再连接。
在急性窦房结电隔离后，19%的 PV 存在 dPVP。dPVP 的存在并不能预测 PVI 后复发性 AF。
