Kumagai Koji, Minami Kentaro, Kutsuzawa Daisuke, Oshima Shigeru
The Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumimachi kou, Maebashi, Gunma 371-0004, Japan.
J Arrhythm. 2016 Jun;32(3):212-7. doi: 10.1016/j.joa.2016.02.005. Epub 2016 Mar 14.
The endpoint of ablation procedures is suggested to be non-inducibility of paroxysmal atrial fibrillation (PAF). However, the prognosis of induced AF/atrial tachycardia (AT) after pulmonary vein isolation (PVI) in PAF patients remains unclear.
A total of 122 PAF patients were divided into the following 3 groups: Group 1, 79 without AF/AT induced after PVI; Group 2, 21 with AF/AT induced or sustained after PVI, and followed by a high-dominant frequency (DF) and continuous complex fractionated atrial electrogram (CFAE) site ablation and, if necessary, linear ablation; and Group 3, 22 with external cardioversion of AF/AT induced or sustained after PVI. High-DF (DF≥8 Hz) and continuous CFAE (fractionated intervals≤50 ms) sites were targeted. The ablation endpoint was non-inducibility of PAF.
In Group 2, AF terminated in 2 patients with a high-DF and continuous CFAE site ablation. In 4 patients, AF induced after cardioversion did not terminate with left atrium linear ablation, and required additional cardioversion. Common atrial flutter in 2 patients terminated with cavotricuspid isthmus ablation. An AT terminated with a roofline ablation. Finally, no AF/AT could be induced in any of the patients in Group 2 after all the procedures. The cumulative freedom from AF/AT recurrence without antiarrhythmic drugs in Groups 1 and 2 was significantly greater than that in Group 3 after 1 procedure during 12 months of follow-up (90% and 91% vs. 64%, Log-rank test P=0.001 and P=0.033, respectively).
Atrial substrate ablation may improve the clinical outcome after ablation in patients after PVI with residual arrhythmia inducibility.
消融手术的终点建议为阵发性心房颤动（PAF）不可诱发。然而，PAF患者肺静脉隔离（PVI）后诱发的房颤/房性心动过速（AT）的预后仍不明确。
总共122例PAF患者被分为以下3组：第1组，79例PVI后未诱发房颤/AT；第2组，21例PVI后诱发或持续房颤/AT，随后进行高主导频率（DF）和持续性碎裂心房电图（CFAE）部位消融，必要时进行线性消融；第3组，22例PVI后诱发或持续的房颤/AT进行体外复律。以高DF（DF≥8 Hz）和持续性CFAE（碎裂间期≤50 ms）部位为靶点。消融终点为PAF不可诱发。
在第2组中，2例患者通过高DF和持续性CFAE部位消融房颤终止。4例患者复律后诱发的房颤经左心房线性消融未终止，需要再次复律。2例患者的常见心房扑动经三尖瓣峡部消融终止。1例AT经房顶线消融终止。最后，第2组所有患者在所有手术操作后均未诱发房颤/AT。在12个月的随访期间，第1组和第2组在1次手术后无抗心律失常药物情况下房颤/AT复发的累积自由度显著高于第3组（分别为9０%和91% 对64%，Log-rank检验P=0.001和P=0.033）。
心房基质消融可能改善PVI后仍有残余心律失常诱发的患者消融后的临床结局。
