与使用当代导管消融技术的射频逐点环肺静脉电隔离相比，在 redo 手术中肺静脉再连接更少。
Less Pulmonary Vein Reconnection at Redo Procedures Following Radiofrequency Point-by-Point Antral Pulmonary Vein Isolation With the Use of Contemporary Catheter Ablation Technologies.
机构信息
Cardiology Department, University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium.
Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain; Instituto de Investigación Sanitaria (IDIS), Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226-CB16/11/00420), Santiago de Compostela, Spain.
出版信息
JACC Clin Electrophysiol. 2018 Dec;4(12):1556-1565. doi: 10.1016/j.jacep.2018.09.020. Epub 2018 Nov 28.
OBJECTIVES
This study investigated whether real-world use of contemporary technologies changed pulmonary vein (PV) reconnection and redo pulmonary vein isolation (PVI) procedure frequencies.
BACKGROUND
Previous studies consistently reported that following PVI recurrence of PV conduction is observed in >80% of patients.
METHODS
Consecutive patients undergoing 529 first and/or redo radiofrequency point-by-point PVI between January 2013 and December 2016 were included.
RESULTS
Between 2013 and 2016, redo PVI rate in atrial fibrillation significantly decreased (p < 0.001); in ≤12 months, first redo PVI rate decreased from 19% to 4%. The percentage of patients having PV reconnection at second PVI significantly decreased from 90% to 29% (p = 0.001). One PVI was performed in 393 and >1 in 79 patients. Female sex was associated with >1 PVI (hazard ratio [HR]: 1.86; 95% confidence interval [CI]: 1.10 to 3.13; p = 0.02). Sixty patients underwent first and second PVI in the study period. Female sex (HR: 2.79; 95% CI: 1.67 to 4.64; p < 0.001) and left atrial diameter (HR: 1.05; 95% CI: 1.01 to 1.08; p = 0.01) were associated with more and use of automatic ablation annotation algorithm during first PVI with fewer (HR: 0.54; 95% CI: 0.32 to 0.92; p = 0.02) redo PVI procedures. In 31 of 60 patients, ≥1 PV was reconnected at second PVI. The need for "touch-up" applications at the first PVI was the only predictor of PV reconnection.
CONCLUSIONS
Redo rate in atrial fibrillation and PV reconnection at redo PVI significantly decreased in recent years. Male sex, left atrial diameter, and use of automatic ablation annotation algorithm at first PVI were associated with fewer redo procedures. First-pass isolation was associated with lower PV reconnection rate at second procedure. Female sex was associated with more redo procedures but not higher PV reconnection frequencies.
目的
本研究旨在探讨在真实世界中使用当代技术是否会改变肺静脉（PV）再连接和再次行肺静脉隔离（PVI）的频率。
背景
既往研究一致报道，在 PVI 后，超过 80%的患者会出现 PV 传导的复发。
方法
连续纳入 2013 年 1 月至 2016 年 12 月间行 529 例首次及/或再次行射频点对点 PVI 的患者。
结果
2013 年至 2016 年间，房颤患者中再次行 PVI 的比例显著下降（p<0.001）；在 12 个月内，首次再次行 PVI 的比例从 19%降至 4%。第二次 PVI 时发生 PV 再连接的患者比例从 90%降至 29%（p=0.001）。有 393 例患者行 1 次 PVI，79 例患者行>1 次 PVI。女性患者行>1 次 PVI 的比例更高（风险比 [HR]：1.86；95%置信区间 [CI]：1.10 至 3.13；p=0.02）。在研究期间，60 例患者行首次和再次 PVI。女性患者（HR：2.79；95% CI：1.67 至 4.64；p<0.001）和左房直径（HR：1.05；95% CI：1.01 至 1.08；p=0.01）与更多次 PVI 相关，而首次 PVI 时使用自动消融标记算法与更少的（HR：0.54；95% CI：0.32 至 0.92；p=0.02）再次行 PVI 相关。在 60 例患者中有 31 例在第二次 PVI 时至少有 1 条 PV 再连接。首次 PVI 时需要“补点”消融是 PV 再连接的唯一预测因素。
结论
近年来，房颤中再次行 PVI 的比例和再次行 PVI 时的 PV 再连接显著下降。男性、左房直径和首次 PVI 时使用自动消融标记算法与较少的再次行 PVI 相关。首次 PVI 时实现了完全电隔离与第二次行 PVI 时较低的 PV 再连接率相关。女性患者与更多的再次行 PVI 相关，但与更高的 PV 再连接频率无关。
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