Electrophysiology Service at the Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Québec, Canada.
Circ Arrhythm Electrophysiol. 2013 Dec;6(6):1103-8. doi: 10.1161/CIRCEP.113.000454. Epub 2013 Oct 4.
Atrial fibrillation recurrence after pulmonary vein (PV) isolation is associated with PV to left atrium reconduction. We prospectively studied the use of 2 procedural techniques designed to facilitate identification of residual gaps within the index ablation line.
After wide circumferential PV isolation, 40 patients received additional ablation targeted at locations of left atrial capture during high-output pacing (pace-capture group), while 40 patients underwent adenosine testing with targeted ablation at sites of dormant conduction (adenosine group). Patients were followed up at 3, 6, and 12 months. After PV isolation, high-output pace-capture was documented in 39 PVs (25%; 50% of patients) in the pace-capture group. Dormant conduction was unmasked in 34 PVs (22%; 53% of patients) in the adenosine group. A subset of 25 patients in the pace-capture group underwent adenosine testing without targeted ablation of dormant conduction. In these patients, only 10 out of 86 PVs (11.6%; 24% of patients) demonstrated dormant conduction after the elimination of local pace-capture. At a follow-up of 329±124 days, the single procedure off antiarrhythmic drug freedom from recurrent atrial fibrillation was 67.5% in the adenosine group and 65.0% in the pace-capture group (P=0.814). Procedure duration and fluoroscopy time were significantly longer in the pace-capture group (P=0.002 and P<0.001), whereas radiofrequency ablation time was comparable (P=0.192).
The use of high-output pacing post-PV isolation results in a significant reduction in the incidence of dormant conduction with a comparable long-term freedom from recurrent atrial fibrillation (versus adenosine-guided ablation). The use of these approaches requires evaluation in a long-term prospective randomized study. [corrected].
肺静脉（PV）隔离后心房颤动（AF）复发与 PV 至左心房再传导有关。我们前瞻性研究了两种程序技术的应用，这些技术旨在帮助识别指数消融线内的残留间隙。
在广泛的 PV 隔离后，40 名患者接受了额外的消融治疗，目标是在高输出起搏期间捕获左心房的位置（起搏捕获组），而 40 名患者接受了腺苷测试，目标是在休眠传导部位进行消融（腺苷组）。患者在 3、6 和 12 个月时进行随访。PV 隔离后，起搏捕获组 39 个 PV（25%；50%的患者）记录到高输出起搏捕获。腺苷组 34 个 PV（22%；53%的患者）揭示了休眠传导。起搏捕获组中有 25 名患者进行了亚组腺苷测试，而没有对休眠传导进行靶向消融。在这些患者中，只有 10 个（11.6%；24%的患者）在消除局部起搏捕获后，86 个 PV 中有 10 个显示出休眠传导。在 329±124 天的随访中，腺苷组和起搏捕获组的单程序抗心律失常药物治疗后无复发性心房颤动的自由率分别为 67.5%和 65.0%（P=0.814）。起搏捕获组的手术时间和透视时间明显更长（P=0.002 和 P<0.001），而射频消融时间相当（P=0.192）。
PV 隔离后使用高输出起搏会显著降低休眠传导的发生率，同时具有相当长的无复发性心房颤动（与腺苷指导消融相比）。这些方法的应用需要在长期前瞻性随机研究中进行评估。
