First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
Texas Heart Institute, Houston, TX.
J Am Heart Assoc. 2017 Mar 2;6(3):e004869. doi: 10.1161/JAHA.116.004869.
The coronary sinus (CS), as a junction of the atria, contributes to atrial fibrillation (AF) by developing unstable reentry, and isolating the atria by ablation at the CS could terminate AF. The present study evaluated whether AF activities at the CS in a subset of patients contributed to AF maintenance and predicted clinical outcome of ablation.
We studied 122 consecutive patients who had a first-time radiofrequency ablation for persistent AF. Bipolar electrograms were obtained from multiple regions of the left atrium by a Lasso mapping catheter before ablation. Pulmonary vein isolation terminated AF in 12 patients (9.8%). Sequential stepwise ablation was conducted in pulmonary vein isolation nontermination patients and succeeded in 22 patients (18%). In the stepwise termination group, AF frequency in the proximal CS (CSp) was significantly higher (10.2±2.1 Hz versus 8.3±1.8 Hz, <0.001), and the ratio of distal CS (CSd) to proximal CS (CSd/CSp ratio, 56.6%±10.11% versus 70.7%±9.8%, <0.001) was significantly lower than that in the nontermination group. The stepwise logistic regression analysis indicated that the CSd/CSp ratio was an independent predictor with an odds ratio of 1.131 (95%CI 1.053-1.214; =0.001). With a cutoff of 67%, the patients with lower CSd/CSp ratios had significantly better index and long-term outcomes than those with higher ratios during a follow-up of 46±18 months.
Rapid repetitive activities in the musculature of the proximal CS may contribute to maintenance of AF after pulmonary vein isolation alone in persistent AF. A cutoff at 67%, of the CSd/CSp frequency ratio might be an indicator to stratify the subset of patients who might benefit from CS ablation.
冠状窦（CS）作为心房的交界处，通过发展不稳定的折返来促进心房颤动（AF），并且通过 CS 消融来隔离心房可以终止 AF。本研究评估了 CS 中的 AF 活动是否有助于 AF 的维持，并预测消融的临床结果。
我们研究了 122 例首次接受射频消融治疗持续性 AF 的连续患者。消融前，通过 Lasso 标测导管获得左心房多个区域的双极电图。肺静脉隔离终止了 12 例患者（9.8%）的 AF。在肺静脉隔离未终止的患者中进行了逐步序贯消融，其中 22 例患者（18%）成功。在逐步终止组中，CSp 近端 CS（CSp）的 AF 频率显著升高（10.2±2.1 Hz 比 8.3±1.8 Hz，<0.001），CSd/CSp 比值（CSd 与 CSp 的比值）显著降低（56.6%±10.11%比 70.7%±9.8%，<0.001）。逐步逻辑回归分析表明，CSd/CSp 比值是一个独立的预测因子，优势比为 1.131（95%CI 1.053-1.214；=0.001）。在 46±18 个月的随访中，CSd/CSp 比值较低的患者在指数和长期结果上明显优于比值较高的患者。
在单独进行肺静脉隔离后，CS 近端肌肉的快速重复活动可能有助于持续性 AF 的维持。CSd/CSp 频率比的截断值为 67%可能是分层 CS 消融获益患者亚组的指标。
