German Heart Center Munich, Technical University of Munich, Munich, Germany. Germany,
Clin Cardiol. 2013 Jul;36(7):422-6. doi: 10.1002/clc.22132. Epub 2013 May 13.
Ablation procedures in patients with paroxysmal atrial fibrillation (PAF) includes isolation of all pulmonary veins (PVs). We hypothesized that an approach using an algorithm to detect arrhythmogenic PVs (aPVs) might lead to shorter procedure duration (PD) and fewer proarrhythmic effects (PE).
Isolation of the aPVs only leads to a reduced PD, reduced PEs, and fewer adverse events, with a success rate comparable to the standard all-PV approach.
In this prospective trial, 207 patients with PAF were randomized to undergo isolation of the aPV (AG group, n = 105) or isolation of all PVs (VG group, n = 102). The aPV was identified by atrial fibrillation (AF) induction, focal discharge, or short local PV decremental conduction during PV pacing. Patients were followed with repetitive 7-day Holter electrocardiograms (ECGs) after 3, 6, and 12 months in our arrhythmia clinic.
In 97% of patients, at least 1 aPV was identified (mean, 2.1). PD did not differ significantly (152.3 ± 57.1 minutes vs 162 ± 68 minutes, P = 0.27) between the groups, but the number of radiofrequency (RF) applications and fluoroscopy time (FT) and dose were significantly lower in the AG group than in the VG group. The occurrence of PE (new-onset atrial tachycardia) and adverse events (AE) did not differ between the 2 groups (P = 0.1). Sinus rhythm off antiarrhythmic medication (documented on 7-day Holter ECGs) 12 months after a single procedure was achieved in 53% in the AG group and 59% in the VG group (P = 0.51).
Isolation of the aPVs detected by a straightforward algorithm leads to similar success rates compared to a standard all-PV approach with regard to PD, AE, or PE and is associated with less RF and a shorter FT.
阵发性心房颤动（PAF）的消融程序包括所有肺静脉（PVs）的隔离。我们假设，使用一种算法检测致心律失常性 PVs（aPVs）的方法可能会导致手术时间（PD）缩短，致心律失常作用（PE）减少。
仅隔离 aPV 会导致 PD 缩短、PE 减少和不良事件减少，成功率与标准全 PV 方法相当。
在这项前瞻性试验中，207 例 PAF 患者被随机分为隔离 aPV 组（AG 组，n=105）或隔离所有 PV 组（VG 组，n=102）。通过心房颤动（AF）诱发、局灶放电或 PV 起搏时短程 PV 递减传导来识别 aPV。患者在我们的心律失常诊所随访 3、6 和 12 个月时，进行重复的 7 天动态心电图（ECG）检查。
在 97%的患者中，至少识别出 1 个 aPV（平均 2.1 个）。两组间 PD 无显著差异（152.3±57.1 分钟与 162±68 分钟，P=0.27），但 AG 组 RF 应用次数、透视时间（FT）和剂量均显著低于 VG 组。PE（新发房性心动过速）和不良事件（AE）的发生在两组间无差异（P=0.1）。单次手术 12 个月后，AG 组和 VG 组分别有 53%和 59%的患者在停用抗心律失常药物后（7 天动态心电图记录）维持窦性节律（P=0.51）。
通过一种简单的算法隔离检测到的 aPV 与标准全 PV 方法相比，在 PD、AE 或 PE 方面具有相似的成功率，并且与更少的 RF 和更短的 FT 相关。
