Iwai Shinsuke, Takahashi Yoshihide, Masumura Mayumi, Yamashita Syu, Doi Junichi, Yamamoto Tasuku, Sakakibara Atsushi, Nomoto Hidetsugu, Yoshida Yoshinori, Sugiyama Tomoyo, Oumi Tetsuo, Ohno Masakazu, Sato Yasuhiro, Hirao Kenzo, Isobe Mitsuaki
Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
J Cardiovasc Electrophysiol. 2017 May;28(5):489-497. doi: 10.1111/jce.13187. Epub 2017 Mar 20.
Catheter ablation can terminate persistent atrial fibrillation (AF). However, atrial tachycardia (AT) often arises after termination of AF.
Of 215 patients who underwent index stepwise ablation for persistent AF, 141 (66%) patients (64 ± 9 years) in whom AF terminated during the ablation procedure were studied. If AF converted into AT, ablation for AT was subsequently performed. ATs were categorized as focal or macroreentrant AT. We assessed whether type of AT occurring after conversion of AF during the ablation procedure was associated with freedom from atrial tachyarrhythmia (AF or AT) during follow-up. Sinus rhythm was directly restored from AF in 37 patients, while 34, 37, and 33 patients had focal AT alone, a mix of focal and macroreentrant AT, and macroreentrant AT alone after termination of AF, respectively. Arrhythmia-free survival rates at 1 year after the index procedure were 30%, 34%, 61%, and 59% in the patients with focal AT alone, a mix of focal AT and macroreentrant AT, macroreentrant AT alone, and direct restoration of sinus rhythm, respectively (P = 0.004). Type of AT occurring during the index procedure was associated with type of recurrent AT (P = 0.03), but the origin of focal AT occurring during the index ablation differed from that of the recurrent AT in 85% of patients.
In patients who had AF termination by ablation, occurrence of focal AT during the ablation procedure was associated with worse clinical outcome than occurrence of macroreentrant AT, likely due to ATs arising from other foci during follow-up.
导管消融可终止持续性心房颤动（房颤）。然而，房颤终止后常出现房性心动过速（房速）。
在215例行持续性房颤初次分步消融的患者中，研究了141例（66%）在消融过程中房颤终止的患者（64±9岁）。如果房颤转变为房速，则随后进行房速消融。房速分为局灶性或大折返性房速。我们评估了消融过程中房颤转变后出现的房速类型与随访期间无房性快速性心律失常（房颤或房速）是否相关。37例患者房颤直接恢复为窦性心律，而房颤终止后分别有34例、37例和33例患者仅出现局灶性房速、局灶性和大折返性房速混合出现、仅出现大折返性房速。初次手术后1年，仅出现局灶性房速、局灶性房速和大折返性房速混合出现、仅出现大折返性房速以及直接恢复窦性心律的患者无心律失常生存率分别为30%、34%、61%和59%（P = 0.004）。初次手术期间出现的房速类型与复发性房速类型相关（P = 0.03），但在85%的患者中，初次消融期间出现的局灶性房速起源与复发性房速的起源不同。
在通过消融终止房颤的患者中，消融过程中出现局灶性房速与比出现大折返性房速更差的临床结局相关，这可能是由于随访期间房速起源于其他病灶。
