Takigawa Masateru, Takahashi Atsushi, Kuwahara Taishi, Okubo Kenji, Takahashi Yoshihide, Nakashima Emiko, Watari Yuji, Yamao Kazuya, Nakajima Jun, Takagi Katsumasa, Kimura Shigeki, Hikita Hiroyuki, Hirao Kenzo, Isobe Mitsuaki
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
J Cardiovasc Electrophysiol. 2015 Jul;26(7):739-46. doi: 10.1111/jce.12681. Epub 2015 May 25.
Paroxysmal atrial fibrillation (AF) is primarily triggered by pulmonary veins (PVs). However, non-PV AF foci may also trigger AF.
We examined 207 patients (mean age, 62 ± 11 years; 166 men) who underwent a second catheter ablation (CA) and evaluated the clinical significance of non-PV AF foci on the outcomes.
Electrical reconnections between the PVs and left atrium (LA) were observed in 162 patients (78.3%). Non-PV AF foci were identified in 95 patients (45.9%, 60 patients with successfully ablated non-PV AF foci and 35 with unmappable non-PV AF foci). During a median follow-up period of 22.7 months, 61 patients (29.5%; 18/112 [16.1%] without non-PV AF foci vs. 20/60 [33.3%] with successfully ablated non-PV AF foci vs. 23/35 [65.7%] with unmappable non-PV AF foci, P < 0.0001) developed AF recurrence; 52 (85.2%) developed recurrence within 1 year. The presence of non-PV AF foci was a significant clinical predictor of AF recurrence after the second CA; successfully ablated non-PV AF foci increased the AF recurrence risk by 2.24 times (95% confidence interval [CI], 1.12-4.54; P = 0.02), and unmappable AF foci increased this risk by 5.58 times (95% CI, 2.73-11.63; P < 0.0001).
Nearly half of the patients had non-PV AF foci at the second CA session. AF recurred after the second CA session in approximately 30%, with most recurrences happening within 1 year. The presence of non-PV AF foci significantly increased the AF recurrence risk after a second CA. When non-PV AF foci were unmappable, the AF recurrence rate was extremely high.
阵发性心房颤动（AF）主要由肺静脉（PVs）触发。然而，非肺静脉房颤病灶也可能触发房颤。
我们检查了207例接受二次导管消融（CA）的患者（平均年龄62±11岁；男性166例），并评估了非肺静脉房颤病灶对预后的临床意义。
162例患者（78.3%）观察到肺静脉与左心房（LA）之间的电连接恢复。95例患者（45.9%）发现非肺静脉房颤病灶（60例非肺静脉房颤病灶成功消融，35例无法标测到非肺静脉房颤病灶）。在中位随访期22.7个月期间，61例患者（29.5%；无非肺静脉房颤病灶的患者中18/112例[16.1%]，非肺静脉房颤病灶成功消融的患者中20/60例[33.3%]，无法标测到非肺静脉房颤病灶的患者中23/35例[65.7%]，P<0.0001）发生房颤复发；52例（85.2%）在1年内复发。非肺静脉房颤病灶的存在是二次导管消融术后房颤复发的重要临床预测因素；非肺静脉房颤病灶成功消融使房颤复发风险增加2.24倍（95%置信区间[CI]，1.12-4.54；P=0.02），无法标测到的房颤病灶使该风险增加5.58倍（95%CI，2.73-11.63；P<0.0001）。
近一半患者在二次导管消融时存在非肺静脉房颤病灶。二次导管消融术后约30%的患者发生房颤复发，大多数复发发生在1年内。非肺静脉房颤病灶的存在显著增加了二次导管消融术后房颤复发风险。当非肺静脉房颤病灶无法标测到时，房颤复发率极高。
