SIR RUN RUN SHAW Institut universitaire de cardiologie et de pneumologie de Québec, Canada.
Europace. 2011 Jul;13(7):949-54. doi: 10.1093/europace/eur093. Epub 2011 Apr 12.
Dissociated pulmonary vein rhythm (PVD) has been taken as a signal of PV isolation, but has been questioned recently; we assessed the relationship between PVD and acute PV reconnection after PV isolation in this study.
Eighty-five consecutive patients (52 males; mean age 59±11 years) were referred for catheter ablation of drug-refractory paroxysmal AF. Following PV isolation, the presence and cycle length of PVD were recorded. Pulmonary veins were classified into veins with PVD (Group 1) and veins without PVD (Group 2). Adenosine triphosphate (ATP) was then injected during isoproterenol infusion to reveal dormant conduction gap(s), and PVs were further remapped at 30 min post-isolation. Totally, PVD was observed in 68% (58 of 85) of patients and 34.7% (112 of 323) of PVs. Seventy-nine (24.5%) PVs were found acutely reconnected, including 48 veins revealed by ATP induction [ATP(+)PV] and 64 veins by reassessment after 30 min post-isolation [Time(+)PV]. Time(+)PVs were observed more frequently in Group 1 than those in Group 2 (31.3 vs. 13.7%, P<0.01), but no significant difference was found in the occurrence of ATP(+)PVs between Group 1 and Group 2 (17.9 vs. 13.3%, P=0.27). The sequences of the PVD and the acutely reconnected PV potential were similar in 87.5% of veins. After PV re-isolation, 70% (28 of 40) of previously documented PVD disappeared.
The occurrence of PVD after PV isolation was closely related to the acute PV reconnection after 30 min post-isolation.
分离的肺静脉节律（PVD）已被视为肺静脉隔离的信号，但最近受到质疑；我们评估了在这项研究中 PVD 与肺静脉隔离后急性肺静脉再连接之间的关系。
85 例连续患者（52 例男性；平均年龄 59±11 岁）因药物难治性阵发性 AF 而行导管消融。肺静脉隔离后，记录 PVD 的存在和周期长度。将肺静脉分为有 PVD 的静脉（组 1）和无 PVD 的静脉（组 2）。然后在异丙肾上腺素输注期间注射三磷酸腺苷（ATP）以显示休眠传导间隙，并在隔离后 30 分钟进一步重新映射肺静脉。总共 68%（85 例中的 58 例）的患者和 34.7%（323 例中的 112 例）的肺静脉观察到 PVD。79 条（24.5%）肺静脉急性再连接，其中 48 条静脉通过 ATP 诱导显示[ATP（+）PV]，64 条静脉通过 30 分钟后重新评估显示[Time（+）PV]。与组 2 相比，组 1 中更频繁地观察到 Time（+）PV（31.3%比 13.7%，P<0.01），但组 1 和组 2 之间 ATP（+）PV 的发生率无显著差异（17.9%比 13.3%，P=0.27）。87.5%的静脉中 PVD 和急性再连接肺静脉电位的序列相似。肺静脉再隔离后，70%（28 例中的 28 例）以前记录的 PVD 消失。
肺静脉隔离后 PVD 的发生与 30 分钟后急性肺静脉再连接密切相关。
