Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8471, Japan.
Europace. 2014 Feb;16(2):208-13. doi: 10.1093/europace/eut159. Epub 2013 Jun 9.
Although patients with paroxysmal atrial fibrillation (AF) and prolonged sinus pauses [tachycardia-bradycardia syndrome (TBS)] are generally treated by permanent pacemaker, catheter ablation has been reported to be a curative therapy for TBS without pacemaker implantation. The purpose of this study was to define the potential role of successful ablation in patients with TBS.
Of 280 paroxysmal AF patients undergoing ablation, 37 TBS patients with both AF and symptomatic sinus pauses (age: 62 ± 8 years; mean maximum pauses: 6 ± 2 s) were analysed. During the 5.8 ± 1.2 years (range: 5-8.7 years) follow-up, both tachyarrhythmia and bradycardia were eliminated by a single procedure in 19 of 37 (51%) patients. Repeat procedures were performed in 14 of 18 patients with tachyarrhythmia recurrence (second: 12 and third: 2 patients). During the repeat procedure, 79% (45 of 57) of previously isolated pulmonary veins (PVs) were reconnected to the left atrium. Pulmonary vein tachycardia initiating the AF was found in 46% (17 of 37) and 43% (6 of 14) of patients during the initial and second procedure, respectively. Finally, 32 (86%) patients remained free from AF after the last procedure. Three patients (8%) required pacemaker implantation, one for the gradual progression of sinus dysfunction during a period of 6.5 years and the others for recurrence of TBS 3.5 and 5.5 years after ablation, respectively.
Catheter ablation can eliminate both AF and prolonged sinus pauses in the majority of TBS patients. Nevertheless, such patients should be continuously followed-up, because gradual progression of sinus node dysfunction can occur after a long period of time.
虽然阵发性心房颤动（AF）和窦性停搏延长的患者（心动过速-心动过缓综合征[TBS]）通常需要植入永久性起搏器，但已有研究报道导管消融术可作为一种无需植入起搏器的 TBS 治疗方法。本研究旨在明确消融术在 TBS 患者中的潜在作用。
在 280 例行消融术的阵发性 AF 患者中，有 37 例 TBS 患者同时存在 AF 和有症状的窦性停搏（年龄：62±8 岁；平均最长停搏时间：6±2s）。在 5.8±1.2 年（范围：5-8.7 年）的随访中，37 例患者中有 19 例（51%）通过单次消融术既消除了心动过速又消除了心动过缓。18 例心动过速复发的患者中有 14 例（第二次：12 例，第三次：2 例）进行了重复消融术。在重复消融术中，79%（45/57）以前孤立的肺静脉（PVs）与左心房重新连接。在初始消融术和第二次消融术中，分别有 46%（17/37）和 43%（6/14）的患者发现引发 AF 的 PV 性心动过速。最后，32 例（86%）患者在最后一次消融术后仍未发生 AF。3 例（8%）患者需要植入起搏器，1 例是由于窦房结功能逐渐恶化（6.5 年后），另外 2 例分别是在消融术后 3.5 年和 5.5 年后 TBS 复发。
导管消融术可以消除大多数 TBS 患者的 AF 和窦性停搏延长。然而，此类患者需要持续随访，因为窦房结功能障碍可能会在很长一段时间后逐渐进展。
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