Lin Frank S, Ip James E, Markowitz Steven M, Liu Christopher F, Thomas George, Lerman Bruce B, Cheung Jim W
Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York.
Pacing Clin Electrophysiol. 2015 May;38(5):598-607. doi: 10.1111/pace.12596. Epub 2015 Feb 14.
Adenosine (ADO) can uncover dormant conduction following pulmonary vein (PV) isolation. We sought to identify the value of dormant conduction for predicting atrial fibrillation (AF) recurrence and chronic PV reconnection.
One hundred fifty-two patients (80 male; age 60 ± 11 years) undergoing PV isolation for AF were studied. After PV isolation, sites of ADO-induced PV reconnection were recorded and targeted with additional ablation. In patients undergoing repeat ablation for recurrent AF, chronic PV reconnection was assessed.
Forty-five (30%) patients had ADO-induced PV reconnection following PV isolation. Dormant conduction was successfully eliminated with additional ablation in 41 (91%) of these patients. After follow-up of 598 ± 270 days, 60 (39%) patients had recurrent AF. Dormant PV conduction was not a significant predictor of AF recurrence (hazard ratio 1.51; 95% confidence interval: 0.89-2.56; P = 0.12) although three of four (75%) patients with residual dormant conduction following initial ablation developed recurrent AF. Twenty-six patients with recurrent AF underwent repeat ablation with 52 of 99 (53%) PVs found to have chronic reconnection. Nine of 11 (82%) PVs with dormant conduction and 43 of 88 (49%) PVs without dormant conduction at initial procedure had chronic reconnection at repeat ablation.
When additional ablation is performed to eliminate ADO-induced PV reconnection after PV isolation, dormant conduction is not a significant predictor of recurrent AF. Although PVs with dormant conduction at initial procedure may develop chronic reconnection, the majority of PVs that show conduction recovery at repeat ablation occur in nondormant PVs.
腺苷（ADO）可在肺静脉（PV）隔离后揭示隐匿性传导。我们试图确定隐匿性传导对预测心房颤动（AF）复发和慢性PV重新连接的价值。
对152例因AF接受PV隔离的患者（80例男性；年龄60±11岁）进行研究。PV隔离后，记录ADO诱导的PV重新连接部位，并进行额外消融。对因复发性AF接受再次消融的患者评估慢性PV重新连接情况。
45例（30%）患者在PV隔离后出现ADO诱导的PV重新连接。其中41例（91%）患者通过额外消融成功消除了隐匿性传导。在598±270天的随访后，60例（39%）患者出现复发性AF。隐匿性PV传导不是AF复发的显著预测因素（风险比1.51；95%置信区间：0.89 - 2.56；P = 0.12），尽管在初次消融后仍有隐匿性传导的4例患者中有3例（75%）发生了复发性AF。26例复发性AF患者接受了再次消融，99条PV中有52条（53%）发现有慢性重新连接。初次手术时有隐匿性传导的11条PV中有9条（82%）以及无隐匿性传导的88条PV中有43条（49%）在再次消融时有慢性重新连接。
在PV隔离后进行额外消融以消除ADO诱导的PV重新连接时，隐匿性传导不是复发性AF的显著预测因素。虽然初次手术时有隐匿性传导的PV可能会发生慢性重新连接，但在再次消融时显示传导恢复的大多数PV发生在无隐匿性传导的PV中。
