广泛肺隔离后左右心房固有神经节丛的特点及其在房颤导管消融术后的临床意义。
Features of intrinsic ganglionated plexi in both atria after extensive pulmonary isolation and their clinical significance after catheter ablation in patients with atrial fibrillation.
机构信息
Cardiovascular Division, Shiroyama Hospital, Osaka, Japan.
Cardiovascular Division, Shiroyama Hospital, Osaka, Japan.
出版信息
Heart Rhythm. 2015 Mar;12(3):470-476. doi: 10.1016/j.hrthm.2014.11.033. Epub 2014 Nov 26.
BACKGROUND
The features of intrinsic ganglionated plexi (GP) in both atria after extensive pulmonary vein isolation (PVI) and their clinical implications have not been clarified in patients with atrial fibrillation (AF).
OBJECTIVE
The purpose of this study was to assess the features of GP response after extensive PVI and to evaluate the relationship between GP responses and subsequent AF episodes.
METHODS
The study population consisted of 216 consecutive AF patients (104 persistent AF) who underwent an initial ablation. We searched for the GP sites in both atria after an extensive PVI.
RESULTS
GP responses were determined in 186 of 216 patients (85.6%). In the left atrium, GP responses were observed around the right inferior GP in 116 of 216 patients (53.7%) and around the left inferior GP in 57 of 216 (26.4%). In the right atrium, GP responses were observed around the posteroseptal area: inside the CS in 64 of 216 patients (29.6%), at the CS ostium in 150 of 216 (69.4%), and in the lower right atrium in 45 of 216 (20.8%). The presence of a positive GP response was an independent risk factor for AF recurrence (hazard ratio 4.04, confidence interval 1.48-11.0) in patients with paroxysmal, but not persistent, AF. The incidence of recurrent atrial tachyarrhythmias in patients with paroxysmal AF with a positive GP response was 51% vs 8% in those without a GP response (P = .002).
CONCLUSION
The presence of GP responses after extensive PVI was significantly associated with increased AF recurrence after ablation in patients with paroxysmal AF.
背景
广泛肺静脉隔离（PVI）后内在神经节丛（GP）的特征及其在房颤（AF）患者中的临床意义尚不清楚。
目的
本研究旨在评估广泛 PVI 后 GP 反应的特征，并评估 GP 反应与随后的 AF 发作之间的关系。
方法
研究人群包括 216 例连续的 AF 患者（104 例持续性 AF），他们接受了初始消融。我们在广泛 PVI 后寻找左右心房中的 GP 部位。
结果
216 例患者中有 186 例（85.6%）确定了 GP 反应。在左心房中，在 216 例患者中有 116 例（53.7%）观察到右下 GP 周围的 GP 反应，在 216 例中有 57 例（26.4%）观察到左下 GP 周围的 GP 反应。在右心房中，GP 反应观察到在后间隔区域：在 216 例患者中有 64 例（29.6%）在 CS 内，在 216 例中有 150 例（69.4%）在 CS 口，在 216 例中有 45 例（20.8%）在右下心房。在阵发性 AF 患者中，存在阳性 GP 反应是 AF 复发的独立危险因素（风险比 4.04，置信区间 1.48-11.0），但在持续性 AF 患者中则不是。在有阳性 GP 反应的阵发性 AF 患者中，复发性房性心律失常的发生率为 51%，而无 GP 反应的患者为 8%（P=0.002）。
结论
广泛 PVI 后存在 GP 反应与阵发性 AF 消融后 AF 复发显著相关。
Zotero 插件