Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, No. 241 West Huaihai Road, Xu Hui District, Shanghai 200030, China.
Europace. 2017 Oct 1;19(10):1670-1675. doi: 10.1093/europace/euw167.
The superior vena cava (SVC) has been established as an important source of atrial fibrillation (AF). The role of SVC in long-standing persistent AF and the efficacy of empiric electrical isolation of the SVC are still unclear. The purpose of this study was to judge the role of SVC in catheter ablation of long-standing persistent AF.
A total of 102 consecutive patients with long-standing persistent AF were enrolled. All patients underwent circumferential pulmonary vein isolation, complex fractionated atrial electrograms ablation, and linear ablation during the index procedure. Superior vena cava-triggered AF and an SVC associated with the maintenance of AF were evaluated by mapping catheters during the procedure. The arrhythmogenicity of the SVC was confirmed in only 1 of the patients (0.98%). At the end of 12 months follow-up, the arrhythmia-free survival rate after a single procedure was 43.1%. After the last procedure (mean 1.47 ± 0.58 procedures), sinus rhythm was maintained in 71 (69.6%) patients, 63 of whom without antiarrhythmic drugs. The patients in AF recurrence group had higher rates of right atrium enlargement (71 vs. 34%, P = 0.03), ≥2 procedures (65 vs. 34%, P < 0.05), longer AF duration (84 ± 46 vs. 45 ± 34 months, P < 0.05), and larger left atrium diameter (50 ± 5 vs. 45 ± 6 mm, P < 0.05). In the multivariate analysis, left atrium diameter and AF duration were independent predictors of AF recurrence.
The arrhythmogenic SVC is rarely detected in patients with long-standing persistent AF. Empiric SVC electrical isolation in the stepwise approach of long-standing persistent AF seems unnecessary.
上腔静脉（SVC）已被确定为心房颤动（AF）的重要来源。SVC 在持续性房颤和经验性电隔离 SVC 的疗效中的作用仍不清楚。本研究的目的是判断 SVC 在持续性房颤导管消融中的作用。
共纳入 102 例持续性房颤患者。所有患者均在指数手术中接受了环形肺静脉隔离、复杂碎裂心房电图消融和线性消融。在手术过程中通过标测导管评估 SVC 触发的 AF 和与 AF 维持相关的 SVC。仅在 1 例患者（0.98%）中证实了 SVC 的致心律失常性。在 12 个月的随访结束时，单次手术后无心律失常的生存率为 43.1%。最后一次手术后（平均 1.47±0.58 次），71 例（69.6%）患者维持窦性心律，其中 63 例未服用抗心律失常药物。在 AF 复发组中，右心房增大的发生率较高（71%比 34%，P=0.03），需要≥2 次手术的比例较高（65%比 34%，P<0.05），AF 持续时间较长（84±46 比 45±34 个月，P<0.05），左心房直径较大（50±5 比 45±6 毫米，P<0.05）。多因素分析显示，左心房直径和 AF 持续时间是 AF 复发的独立预测因素。
在持续性房颤患者中很少发现心律失常性 SVC。在持续性房颤的逐步治疗中，经验性电隔离 SVC 似乎是不必要的。
