Baldinger Samuel H, Chinitz Jason S, Kapur Sunil, Kumar Saurabh, Barbhaiya Chirag R, Fujii Akira, Romero Jorge, Epstein Laurence M, John Roy, Tedrow Usha B, Stevenson William G, Michaud Gregory F
Cardiac Arrhythmia Center, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Cardiac Arrhythmia Center, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
JACC Clin Electrophysiol. 2016 Nov;2(6):723-731. doi: 10.1016/j.jacep.2016.05.013. Epub 2016 Aug 3.
The aim of this study was to categorize arrhythmia mechanisms and to summarize ablation strategies in patients with persistent pulmonary vein isolation (PVI) at the time of redo procedures.
Persistent PVI is more frequently seen in patients undergoing redo procedures for recurrent atrial arrhythmias after catheter ablation for atrial fibrillation (AF).
Consecutive patients who underwent their first AF ablation procedures at Brigham and Women's Hospital were screened and included if they had persistent isolation of all pulmonary veins at the time of redo procedures.
Of 300 consecutive patients undergoing first AF ablation procedures, redo procedures were performed in 63 (21%), and 26 patients (9%) had persistent PVI. Of those, 11 had recurred with AF and 15 with organized atrial tachycardia (AT). During the index procedure, linear ablation was performed in 46% of patients with recurrent AF and 93% with recurrent organized AT (p = 0.020). At the time of last follow-up, 2 of 10 patients (20%) in the AF group and 10 of 15 patients (67%) in AT group were in sinus rhythm, without class I or III antiarrhythmic drugs (p = 0.022).
Patients with recurrence of atrial arrhythmia despite persistent PVI frequently present with organized AT. Linear ablation during the index procedure is associated with recurrence of organized AT. Recurrence rates after redo procedures were higher if patients had recurrent AF after the index procedure, and these patients often presented with AF again. Patients with recurrent AF despite persistent PVI may represent a population with lower success rates of catheter ablation.
本研究旨在对持续性肺静脉隔离（PVI）患者在再次手术时的心律失常机制进行分类，并总结消融策略。
在因心房颤动（AF）行导管消融术后复发性房性心律失常而接受再次手术的患者中，持续性PVI更为常见。
筛选在布莱根妇女医院接受首次AF消融手术的连续患者，若他们在再次手术时所有肺静脉均处于持续性隔离状态，则纳入研究。
在300例接受首次AF消融手术的连续患者中，63例（21%）接受了再次手术，其中26例（9%）存在持续性PVI。其中，11例复发AF，15例复发有组织的房性心动过速（AT）。在初次手术期间，46%的复发AF患者和93%的复发有组织AT患者进行了线性消融（p = 0.020）。在最后一次随访时，AF组10例患者中有2例（20%）、AT组15例患者中有10例（67%）处于窦性心律，未使用I类或III类抗心律失常药物（p = 0.022）。
尽管存在持续性PVI，但房性心律失常复发的患者常表现为有组织的AT。初次手术期间的线性消融与有组织AT的复发有关。如果患者在初次手术后复发AF，再次手术后的复发率更高，且这些患者常再次出现AF。尽管存在持续性PVI但复发AF的患者可能代表导管消融成功率较低的人群。
