Miyazaki Shinsuke, Taniguchi Hiroshi, Kusa Shigeki, Ichihara Noboru, Nakamura Hiroaki, Hachiya Hitoshi, Iesaka Yoshito
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Heart Rhythm. 2014 Sep;11(9):1560-6. doi: 10.1016/j.hrthm.2014.06.016. Epub 2014 Jun 13.
The superior vena cava (SVC) is an infrequent but important source of atrial fibrillation (AF), but is not always easy to identify.
This study aimed to identify predictors of an arrhythmogenic SVC (a-SVC) in patients undergoing AF ablation.
Eight hundred thirty-six consecutive patients undergoing AF ablation were analyzed. All patients underwent pulmonary vein antrum isolation during the index procedure. An a-SVC, defined as SVC-triggered AF and an SVC associated with the maintenance of AF, was evaluated by mapping catheters throughout the procedure.
An a-SVC was identified in 44 patients (5.3%) during a total of 1063 procedures. Patients with an a-SVC were younger, less obese, and had a smaller left atrial (LA) size and more paroxysmal AF than those without an a-SVC. The presence of structural heart disease and hypertension was lower, and the coexistence of spontaneous common atrial flutter (AFL) before or during the index procedure was higher in those with an a-SVC than in those without. A multiple logistic regression analysis revealed that the LA size (odds ratio 0.93; 95% confidence interval 0.88-0.99; P = .038) and coexistence of spontaneous common AFL (odds ratio 2.01; 95% confidence interval 1.00-4.02; P = .048) were independent predictors identifying an a-SVC. Although 19 patients (43.2%) required repeat procedures, 39 (88.6%) were free from any atrial tachyarrhythmias without antiarrhythmic drugs at a median of 16.5 months (25th-75th percentiles 9.0-27.0 months) after a mean of 1.5 ± 0.7 procedures.
A smaller LA size and coexistence of spontaneous common AFL were independent predictors of an a-SVC in the context of AF ablation.
上腔静脉（SVC）是心房颤动（AF）的一个少见但重要的来源，但并不总是易于识别。
本研究旨在确定接受AF消融的患者中致心律失常性上腔静脉（a-SVC）的预测因素。
对836例连续接受AF消融的患者进行分析。所有患者在初次手术期间均接受了肺静脉前庭隔离。通过在整个手术过程中使用标测导管评估a-SVC，其定义为SVC触发的AF以及与AF维持相关的SVC。
在总共1063例手术中，44例患者（5.3%）被识别出存在a-SVC。与无a-SVC的患者相比，有a-SVC的患者更年轻、肥胖程度更低、左心房（LA）尺寸更小且阵发性AF更多。结构性心脏病和高血压的发生率更低，且在初次手术前或手术期间自发常见心房扑动（AFL）的共存情况在有a-SVC的患者中比无a-SVC的患者更高。多因素逻辑回归分析显示，LA尺寸（比值比0.93；95%置信区间0.88-0.99；P = 0.038）和自发常见AFL的共存情况（比值比2.01；95%置信区间1.00-4.02；P = 0.048）是识别a-SVC的独立预测因素。尽管19例患者（43.2%）需要再次手术，但在平均1.5±0.7次手术后的中位时间16.5个月（第25-75百分位数为9.0-27.0个月）时，39例（88.6%）患者在未使用抗心律失常药物的情况下未出现任何房性快速性心律失常。
在AF消融的背景下，较小的LA尺寸和自发常见AFL的共存是a-SVC的独立预测因素。
