Heart Rhythm Management Centre, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
Electrophysiology unit Villa Maria Cecilia Hospital, GVM, Via Corriera 1, 48033 Cotignola, Italy.
Europace. 2018 May 1;20(5):778-785. doi: 10.1093/europace/eux117.
The predictive value of induction studies after catheter ablation for atrial fibrillation (AF) is still debatable. To date, these studies have not been implemented in patients after cryoballoon (CB) ablation. Our aim was to analyse the clinical value of AF induction in patients treated by second generation CB for paroxysmal AF.
Seventy patients underwent at first an isoproterenol challenge after pulmonary vein (PV) isolation to assess AF induction and early PV reconnections (EPVR). Patients without EPVR were evaluated for premature atrial contraction (PAC) induction; atrial ectopy was considered frequent (PAC+) if >1/10 cycles or >6/min. After restitution of baseline heart rate, rapid atrial pacing (RAP) was performed on all patients. AF induction by isoproterenol occurred only in 3/70 (4%) patients of whom 2/3 (66%) patients with an EPVR of a triggering vein. In the 62 patients without EPVR, PAC+ occurred in 17 patients (27%). RAP could induce AF in 23/70 (33%) patients. At a mean follow-up of 13.5 months, there were 11/70 (16%) AF recurrences. There was no significant difference in the AF recurrence rate between RAP inducible vs. non-inducible patients (log-rank P = 0.33). A 41% recurrence rate (7/17 patients) was seen in the PAC+ group with significantly different AF-free survival for PAC+ vs. PAC- patients (log rank P < 0.0001). PAC+ was the only independent determinant to predict AF recurrence after multivariate analysis.
PAC occurrence in response to isoproterenol could predict AF recurrence after PV isolation by CB, while RAP showed no prognostic implication.
导管消融治疗心房颤动（AF）后诱发研究的预测价值仍存在争议。迄今为止，这些研究尚未在冷冻球囊（CB）消融后的患者中实施。我们的目的是分析第二代 CB 治疗阵发性 AF 患者中 AF 诱发的临床价值。
70 例患者首先在肺静脉（PV）隔离后进行异丙肾上腺素挑战，以评估 AF 诱发和早期 PV 再连接（EPVR）。无 EPVR 的患者评估早发性房性收缩（PAC）诱发情况；如果>1/10 个周期或>6/分钟，则认为房性异位为频发（PAC+）。在恢复基础心率后，所有患者均进行快速心房起搏（RAP）。异丙肾上腺素诱发 AF 仅发生在 70 例患者中的 3 例（4%），其中 2/3（66%）患者存在触发静脉的 EPVR。在 62 例无 EPVR 的患者中，17 例（27%）患者出现 PAC+。RAP 可诱发 70 例患者中的 23 例（33%）AF。在平均 13.5 个月的随访中，70 例患者中有 11 例（16%）发生 AF 复发。RAP 可诱发 AF 与不可诱发 AF 的患者之间的 AF 复发率无显著差异（对数秩 P=0.33）。PAC+组的复发率为 41%（7/17 例患者），PAC+与 PAC-患者的 AF 无复发生存率存在显著差异（对数秩 P<0.0001）。多变量分析显示，PAC+是预测 CB 隔离后 PV 复发的唯一独立决定因素。
异丙肾上腺素反应中的 PAC 发生可预测 CB 治疗后的 AF 复发，而 RAP 显示无预后意义。
