Elayi Claude S, Di Biase Luigi, Bai Rong, Burkhardt J David, Mohanty Prasant, Santangeli Pasquale, Sanchez Javier, Hongo Richard, Gallinghouse G Joseph, Horton Rodney, Bailey Shane, Beheiry Salwa, Natale Andrea
Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA.
J Cardiovasc Electrophysiol. 2013 Nov;24(11):1199-206. doi: 10.1111/jce.12252. Epub 2013 Sep 10.
Pulmonary vein antrum isolation (PVAI) remains associated with atrial fibrillation (AF) recurrence. We administered adenosine and isoproterenol (ISP) after PVAI to uncover non-PV atrial triggers and PV reconnection, potentially increasing ablation success rate.
One hundred and ninety-two consecutive patients with symptomatic AF presenting for PVAI were prospectively studied (group 1). Following PVAI, adenosine (18-24 mg) and ISP (20-30 mcg/min) were administered intravenously. Supplemental ablation was performed in patients with non-PV triggers that induced AF (group 1A). Other subgroups included patients with (group 1B) or without (group 1C) consistent non-PV atrial foci that did not induce AF. A cohort of 196 matched control patients undergoing PVAI without drug challenge was used for comparison (group 2).
A total of 132 atrial non-PV foci were revealed (31 inducing AF). The majority of atrial foci were observed with ISP (113/132, 86%). Less than 5% of patients had persistent PV recovery during the drug challenge. During a mean follow-up of 22 ± 8 months, PVAI was successful in 110/192 (57%, group 1) versus 100/196 (52%, group 2), P = 0.038. Furthermore, the success rate was statistically different between group 1A (25/32, 78%), group 1B (28/83, 34%), and group 1C (57/74, 74%), P < 0.001.
After PVAI, ablation guided by the administration of adenosine and ISP to target non-PV triggers inducing AF increased AF ablation outcomes. Patients with non-PV foci that did not induce AF had no further ablation, with the lowest ablation success rate. This group may likely benefit from further ablation after PVAI.
肺静脉前庭隔离术（PVAI）仍与房颤（AF）复发相关。我们在PVAI术后给予腺苷和异丙肾上腺素（ISP），以发现非肺静脉心房触发灶和肺静脉重新连接，可能提高消融成功率。
前瞻性研究192例因症状性房颤前来接受PVAI的连续患者（1组）。PVAI术后，静脉注射腺苷（18 - 24 mg）和ISP（20 - 30 mcg/min）。对诱发房颤的非肺静脉触发灶患者进行补充消融（1A组）。其他亚组包括有（1B组）或无（1C组）未诱发房颤的一致非肺静脉心房灶的患者。选取196例接受PVAI但未进行药物激发试验的匹配对照患者作为对照组（2组）进行比较。
共发现132个心房非肺静脉灶（31个诱发房颤）。大多数心房灶是在使用ISP时观察到的（113/132，86%）。在药物激发试验期间，不到5%的患者出现持续性肺静脉恢复。在平均22±8个月的随访中，PVAI在1组110/192例（57%）患者中成功，而在2组100/196例（52%）患者中成功，P = 0.038。此外，1A组（25/32，78%）、1B组（28/83，34%）和1C组（57/74，74%）之间的成功率有统计学差异，P < 0.001。
PVAI术后，以腺苷和ISP给药为指导针对诱发房颤的非肺静脉触发灶进行消融可提高房颤消融效果。未诱发房颤的非肺静脉灶患者未进行进一步消融，消融成功率最低。该组患者可能在PVAI术后进一步消融中获益。
