Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Heart Rhythm. 2018 May;15(5):660-665. doi: 10.1016/j.hrthm.2017.10.023. Epub 2017 Oct 19.
Previous studies have suggested a role of atrial arrhythmia inducibility as an endpoint of catheter ablation of atrial fibrillation (AF). The prognostic value of noninducibility after ablation and of a change in inducibility status has not been investigated in large studies.
The purpose of this study was to evaluate the prognostic role of noninducibility and of a change in inducibility status after ablation of AF.
We studied 305 consecutive patients with AF (66% paroxysmal) undergoing antral pulmonary vein (PV) isolation plus non-PV triggers ablation. All patients underwent a standardized induction protocol before and after ablation from the coronary sinus and right atrium: 15-beat burst pacing at 250 ms and decrementing to 180 ms (up to 20 μg/min isoproterenol). Inducibility was defined as any sustained AF or organized atrial tachycardia (AT) lasting >2 minutes.
A total of 197 patients (65%) had inducible AF/AT at baseline compared to 118 (39%) after ablation. One hundred seven patients (57%) changed their inducibility status from inducible preablation to noninducible postablation. After 19 ± 7 months of follow-up, 212 patients (70%) remained free from any recurrent AF/AT. Noninducibility of AF/AT postablation (log-rank P = .236) or change in inducibility status (log-rank P = .429) was not associated with reduced risk of recurrent AF/AT. Results were consistent across the paroxysmal and nonparoxysmal subgroups.
Noninducibility of atrial arrhythmia or change in inducibility status after PV isolation and non-PV trigger ablation is not associated with long-term freedom from recurrent arrhythmia and should not be used as an ablation endpoint or to support the appropriateness of additional ablation lesion sets.
先前的研究表明，心房颤动（AF）导管消融的终点是心房心律失常的可诱导性。消融后不能诱导以及可诱导性状态变化的预后价值尚未在大型研究中进行研究。
本研究旨在评估 AF 消融后不能诱导以及可诱导性状态变化的预后作用。
我们研究了 305 例连续的 AF（66%为阵发性）患者，这些患者接受了肺静脉（PV）隔离加非-PV 触发消融术。所有患者在消融前后均接受了来自冠状窦和右心房的标准化诱导方案：15 次 250 ms 短阵刺激，递减至 180 ms（最多 20 μg/min 异丙肾上腺素）。诱导性定义为任何持续 >2 分钟的持续性 AF 或有组织的房性心动过速（AT）。
与消融后相比，共有 197 例（65%）患者在基线时有可诱导的 AF/AT，而 118 例（39%）患者在消融后有可诱导的 AF/AT。107 例（57%）患者的可诱导性状态从消融前的可诱导变为消融后的不可诱导。随访 19 ± 7 个月后，212 例（70%）患者无任何复发性 AF/AT。AF/AT 消融后的不可诱导性（log-rank P =.236）或可诱导性状态的变化（log-rank P =.429）与复发性 AF/AT 风险降低无关。结果在阵发性和非阵发性亚组中均一致。
在 PV 隔离和非-PV 触发消融后，心房心律失常的不可诱导性或可诱导性状态的变化与长期无复发性心律失常无关，不应作为消融终点或支持额外消融病灶集的适当性。
