Shiroyama Hospital, Cardiovascular Division, Osaka, Japan.
Shiroyama Hospital, Cardiovascular Division, Osaka, Japan.
Can J Cardiol. 2014 Dec;30(12):1535-40. doi: 10.1016/j.cjca.2014.10.013. Epub 2014 Oct 15.
The mechanism of persistent atrial fibrillation (AF) is multifactorial, and arrhythmogenic foci (AMF) might be involved in the occurrence of persistent AF. In this study, we examined the electrophysiological features of AMF during and immediately after ablation, and evaluated the relationship between the presence and number of residual AMF on the risk of AF recurrence after a vigorous sinus rhythm restoration ablation in patients with long-standing persistent AF.
The study consisted of 117 consecutive patients with persistent AF who underwent catheter ablation (CA). We performed direct cardioversion to restore sinus rhythm before the pulmonary vein (PV) isolation and at the end of the CA. Then we evaluated the features of the AMF inducible with isoproterenol and the pacing-based AF inducibility.
After the completion of ablation, AF could still be induced in 37 of 117 patients (31.6%). Spontaneous PV AMF during CA were observed in 104 of 117 patients (91%), and non-PV AMF in 63 of 117 (54%). Residual non-PV AMF were significantly associated with the pacing-based AF inducibility and an enlarged left atrial volume. In the multivariate analysis, the AF duration (1.01 [range, 1.00-1.02] months; P = 0.012), left atrial volume (1.01 [range, 1.01-1.02] mm; P = 0.006), and residual AMF (3.95 [range, 1.32-11.8] yes, no; P = 0.004) were independent risk factors for recurrent AF.
Residual AMF are associated with an increased long-term AF recurrence after sinus rhythm restoration ablation for long-standing persistent AF.
持续性心房颤动（AF）的发病机制是多因素的，可能涉及致心律失常病灶（AMF）。在这项研究中，我们检查了 AMF 在消融过程中和消融后即刻的电生理特征，并评估了在长期持续性 AF 患者中，窦性心律恢复消融后，残留 AMF 的存在和数量与 AF 复发风险之间的关系。
这项研究包括 117 例持续性 AF 患者，他们接受了导管消融（CA）。我们在肺静脉（PV）隔离前和 CA 结束时进行直接电复律以恢复窦性心律。然后，我们评估了异丙肾上腺素诱导 AMF 的特征和起搏诱导 AF 的可诱发性。
消融完成后，117 例患者中有 37 例（31.6%）仍可诱发 AF。在 117 例患者中有 104 例（91%）在 CA 期间观察到自发性 PV AMF，63 例（54%）观察到非-PV AMF。残留的非-PV AMF 与起搏诱导 AF 的可诱发性和左心房容积增大显著相关。在多变量分析中，AF 持续时间（1.01[范围，1.00-1.02]个月；P=0.012）、左心房容积（1.01[范围，1.01-1.02]mm；P=0.006）和残留 AMF（3.95[范围，1.32-11.8]是，否；P=0.004）是 AF 复发的独立危险因素。
残留的 AMF 与长期持续性 AF 患者窦性心律恢复消融后 AF 复发的长期风险增加有关。
