Hayashi Kentaro, An Yoshimori, Nagashima Michio, Hiroshima Kenichi, Ohe Masatsugu, Makihara Yu, Yamashita Kennosuke, Yamazato Schoichiro, Fukunaga Masato, Sonoda Koichiro, Ando Kenji, Goya Masahiko
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Heart Rhythm. 2015 Sep;12(9):1918-24. doi: 10.1016/j.hrthm.2015.05.003. Epub 2015 May 8.
Pulmonary vein (PV) isolation is an established treatment strategy for paroxysmal atrial fibrillation (PAF). However, the recurrence rate of PAF is 8% to 37%, despite repeated procedures, and the catheter ablation strategy for PAF with non-PV foci is unclear.
The purpose of this study was to assess the PAF ablation strategy for non-PV foci.
The study included 304 consecutive patients undergoing PAF ablation (209 males, age 63.0 ± 10.4 years) divided into 3 groups: group 1 (245 patients) with no inducible non-PV foci; group 2 (34 patients) with atrial fibrillation (AF) originating from non-PV foci and all the foci successfully ablated; and group 3 (25 patients) with AF originating from non-PV triggers, but without all foci being ablated or with persistently inducible AF.
Mean follow-up period was 26.9 ± 11.8 months, and AF recurrence rates since the last procedure were 9.8%, 8.8%, and 68.0% in groups 1, 2, and 3, respectively. There was no statistically significant difference in recurrence rate between groups 1 and 2 (P = .89); however, there were statistically significant differences between groups 3 and 1 (P <.0001) and groups 3 and 2 (P <.0001). The patients in group 2 had an AF-free outcome to equivalent to those who had PV foci in group 1 (P = .83).
Success rates can be improved for PAF ablation if non-PV foci are detected and eliminated.
肺静脉隔离术是阵发性心房颤动（PAF）的既定治疗策略。然而，尽管进行了多次手术，PAF的复发率仍为8%至37%，且PAF合并非肺静脉起源灶的导管消融策略尚不清楚。
本研究旨在评估PAF合并非肺静脉起源灶的消融策略。
该研究纳入了304例连续接受PAF消融的患者（209例男性，年龄63.0±10.4岁），分为3组：第1组（245例患者）无可诱发的非肺静脉起源灶；第2组（34例患者）房颤（AF）起源于非肺静脉起源灶且所有起源灶均成功消融；第3组（25例患者）AF起源于非肺静脉触发灶，但并非所有起源灶均被消融或房颤持续可诱发。
平均随访期为26.9±11.8个月，第1、2、3组自上次手术后的房颤复发率分别为9.8%、8.8%和68.0%。第1组和第2组的复发率无统计学显著差异（P = 0.89）；然而，第3组与第1组（P < 0.0001）和第3组与第2组（P < 0.0001）之间存在统计学显著差异。第2组患者的无房颤结局与第1组有肺静脉起源灶的患者相当（P = 0.83）。
如果检测并消除非肺静脉起源灶，PAF消融的成功率可以提高。
