窦房结动脉起源对阵发性心房颤动患者肺静脉隔离术后复发的影响。

Impact of the origin of sinus node artery on recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation.

机构信息

Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.

出版信息

Chin Med J (Engl). 2013;126(9):1624-9.

PMID:23652040

Abstract

BACKGROUND

Major atrial coronary arteries, including the sinus node artery (SNA), were commonly found in the areas involved in atrial fibrillation (AF) ablation and could cause difficulties in achieving linear block at the left atrial (LA) roof. The SNA is a major atrial coronary artery of the atrial coronary circulation. This study aimed to determine impact of the origin of SNA on recurrence of AF after pulmonary vein isolation (PVI) in patients with paroxysmal AF.

METHODS

Seventy-eight patients underwent coronary angiography for suspected coronary heart disease, followed by catheter ablation for paroxysmal AF. According to the origin of SNA from angiographic findings, they were divided into right SNA group (SNA originating from the right coronary artery) and left SNA group (SNA originating from the left circumflex artery). Guided by an electroanatomic mapping system, circumferential pulmonary vein ablation (CPVA) was performed in both groups and PVI was the procedural endpoint. All patients were followed up at 1, 3, 6, 9 and 12 months post-ablation. Recurrence was defined as any episode of atrial tachyarrhythmias (ATAs), including AF, atrial flutter or atrial tachycardia, that lasted longer than 30 seconds after a blanking period of 3 months.

RESULTS

The SNA originated from the right coronary artery in 34 patients (43.6%) and the left circumflex artery in 44 patients (56.4%). Freedom from AF and antiarrhythmic drugs (AADs) at 1 year was 67.9% (53/78) for all patients. After 1 year follow-up, 79.4% (27/34) in right SNA group and 59.1% (26/44) in left SNA group (P = 0.042) were in sinus rhythm. On multivariate analysis, left atrium size (HR = 1.451, 95%CI: 1.240 - 1.697, P < 0.001) and a left SNA (HR = 6.22, 95%CI: 2.01 - 19.25, P = 0.002) were the independent predictors of AF recurrence.

CONCLUSIONS

The left SNA is more frequent in the patients with paroxysmal AF. After one year follow-up, the presence of a left SNA was identified as an independent predictor of AF recurrence after CPVA in paroxysmal AF.

摘要

背景

大的心房冠状血管，包括窦房结动脉（SNA），通常在涉及到心房颤动（AF）消融的区域中被发现，并且可能在左心房（LA）房顶处实现线性阻断时造成困难。SNA 是心房冠状循环的主要心房冠状血管。本研究旨在确定 SNA 的起源对阵发性 AF 患者肺静脉隔离（PVI）后 AF 复发的影响。

方法

78 例疑似冠心病患者行冠状动脉造影，随后行导管消融治疗阵发性 AF。根据 SNA 的起源，将其分为右 SNA 组（SNA 起源于右冠状动脉）和左 SNA 组（SNA 起源于左回旋支）。在电解剖标测系统的引导下，两组均进行环形肺静脉消融（CPVA），PVI 为程序终点。所有患者均在消融后 1、3、6、9 和 12 个月进行随访。复发定义为任何持续 30 秒以上的房性心动过速（ATAs）发作，包括 AF、房扑或房性心动过速，空白期为 3 个月。

结果

34 例患者（43.6%）的 SNA 起源于右冠状动脉，44 例患者（56.4%）起源于左回旋支。所有患者 1 年无 AF 和抗心律失常药物（AADs）的比例为 67.9%（53/78）。1 年随访后，右 SNA 组的 79.4%（27/34）和左 SNA 组的 59.1%（26/44）（P=0.042）窦性心律。多因素分析显示，左心房大小（HR=1.451，95%CI：1.240-1.697，P＜0.001）和左 SNA（HR=6.22，95%CI：2.01-19.25，P=0.002）是 AF 复发的独立预测因素。