Lin David, Santangeli Pasquale, Zado Erica S, Bala Rupa, Hutchinson Mathew D, Riley Michael P, Frankel David S, Garcia Fermin, Dixit Sanjay, Callans David J, Marchlinski Francis E
Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Cardiovasc Electrophysiol. 2015 Apr;26(4):371-377. doi: 10.1111/jce.12603. Epub 2015 Jan 28.
Pulmonary vein (PV) status, arrhythmia sources, and outcomes with ≥3 ablation procedures have not been characterized.
All patients with ≥3 procedures were included and underwent antral reisolation of reconnected PVs and ablation of non-PV triggers. Of 2,886 patients who underwent PVI, 181 (6%) had more than 2 ablation procedures (3 procedures in 146 and ≥4 procedures in 35). In 12 patients, the clinical arrhythmia was other than AF. Of the remaining 169 patients, 69 (41%) had 4 reconnected PVs, 27 (16%) had 3, 31 (18%) had 2, and 29 (17%) had 1. Only 13 (8%) had all PVs still isolated. Provocative techniques in 127 patients initiated PV triggers in 92 patients, including AF or PV atrial tachycardia in 64 (50%), and reproducible PV APDs in 28 (22%). Thirty-six (20%) had a new non-PV trigger targeted. At a mean of 36 months (12-119 months) after last procedure, 63 patients (47%) had no AF off antiarrhythmic drugs (AAD); 28 (21%) had no AF with AAD; and 18 (13%) had rare AF with good symptom control; 26 patients (19%) had recurrent AF.
At time of third or greater AF ablation, PV reconnection is the rule (92%) and PV triggers initiating AF can be demonstrated. Following repeat PVI and targeting non-PV triggers, 81% of patients had clinical AF control. Our findings suggest that PV reisolation and attempts to identify and eliminate non-PV triggers are effective and support the role of multiple repeat procedures for AF recurrence.
肺静脉（PV）状态、心律失常来源以及≥3次消融手术的结果尚未得到明确描述。
纳入所有接受≥3次手术的患者，并对重新连接的PV进行窦部再次隔离以及对非PV触发灶进行消融。在2886例行肺静脉隔离术（PVI）的患者中，181例（6%）接受了超过2次消融手术（146例接受3次手术，35例接受≥4次手术）。12例患者的临床心律失常并非房颤。在其余169例患者中，69例（41%）有4条重新连接的PV，27例（16%）有3条，31例（18%）有2条，29例（17%）有1条。仅有13例（8%）所有PV仍处于隔离状态。127例患者采用激发技术，92例患者诱发出PV触发灶，其中64例（50%）诱发房颤或PV房性心动过速，28例（22%）诱发出可重复的PV房性早搏。36例（20%）有新的非PV触发灶被靶向消融。在最后一次手术后平均36个月（12 - 119个月）时，63例患者（47%）停用抗心律失常药物（AAD）后无房颤发作；28例（21%）使用AAD时无房颤发作；18例（13%）有罕见房颤发作但症状控制良好；26例患者（19%）有房颤复发。结论：在第三次或更多次房颤消融时，PV重新连接是常见情况（92%），且可证实引发房颤的PV触发灶。在重复PVI并靶向非PV触发灶后
