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广泛左心房前壁消融导致的左心耳隔离在房颤患者中的临床疗效。

The clinical efficacy of left atrial appendage isolation caused by extensive left atrial anterior wall ablation in patients with atrial fibrillation.

作者信息

Park Hwan-Cheol, Lee DaeIn, Shim Jaemin, Choi Jong-Il, Kim Young-Hoon

机构信息

Department of Internal Medicine, College of Medicine, Hanyang University Guri Hospital, Guri City, Republic of Korea.

Arrhyhmia Center, College of Medicine, Korea University Medical Center, Seoul, Republic of Korea.

出版信息

J Interv Card Electrophysiol. 2016 Sep;46(3):287-97. doi: 10.1007/s10840-016-0116-7. Epub 2016 Mar 7.

Abstract

BACKGROUND

The left atrial appendage (LAA) can be a source of atrial fibrillation (AF) triggering or a part of reentry. We sought to determine the characteristics and clinical outcomes of patients with LAA potential delay including electrical isolation (LAAEI) following LA anterior wall (LAAW) ablation for AF.

METHODS

LAAW ablation cases were collected from among 846 patients who underwent catheter ablation (CA). A total of 89 patients were enrolled; they were divided into three groups according to the extent of LAA potential injury. The ejection fractions (EFs) of the LAA and LA were measured by means of LA angiograms.

RESULTS

The mean age of all patients was 56.2 ± 10.7 years (74 males, 83 %). In 47 of the 89 patients, an LAA potential delay was identified after LAAW ablation (group 2). LAAEI was seen in 18 patients (group 3). In the remaining 24 patients, there was no LAA potential delay or LAAEI (group 1). The mean EF decreased significantly after CA in group 3 (P < 0.001). At 21-month follow-up, three patients (17 %) in group 3 had recurrence compared with 11 (42 %) in group 2 and 12 (46 %) in group 3 (P = 0.028). In multivariate analysis, diabetes mellitus and LAA potential delay were independent predictors of AF recurrence (P = 0.021, P = 0.008, respectively).

CONCLUSION

Ablation of the LA anterior wall near the insertion of Bachmann's bundle and the neck of the LAA resulting in LAA potential delay or electrical isolation is effective in preventing recurrence of atrial fibrillation.

摘要

背景

左心耳(LAA)可能是心房颤动(AF)触发的来源或折返的一部分。我们试图确定在进行AF的左房前壁(LAAW)消融后存在包括电隔离(LAAEI)在内的LAA潜在延迟的患者的特征和临床结局。

方法

从846例行导管消融(CA)的患者中收集LAAW消融病例。共纳入89例患者;根据LAA潜在损伤程度将其分为三组。通过左房造影测量LAA和左房的射血分数(EFs)。

结果

所有患者的平均年龄为56.2±10.7岁(74例男性,占83%)。89例患者中有47例在LAAW消融后出现LAA潜在延迟(第2组)。18例患者出现LAAEI(第3组)。其余24例患者未出现LAA潜在延迟或LAAEI(第1组)。第3组CA后平均EF显著降低(P<0.001)。在21个月的随访中,第3组有3例患者(17%)复发,而第2组为11例(42%),第1组为12例(46%)(P=0.028)。多因素分析显示,糖尿病和LAA潜在延迟是AF复发的独立预测因素(分别为P=0.02

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