Hu Jiqiang, Kuang Wu, Cui Xiaoyun, Li Yan, Wu Yang, Lin Qian, Wang Xuan
Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Fanggu Road, Beijing 100078, China.
Cardiol Res Pract. 2018 Dec 10;2018:1834514. doi: 10.1155/2018/1834514. eCollection 2018.
A concealed pulmonary vein (PV) bigeminy (cPVB) may be found in some patients with atrial fibrillation (AF) during sinus rhythm (SR). The aim of this study was to investigate whether the presence of cPVB during SR is associated with a higher PV firing.
Seven hundred seventy-six PVs (excluding 5 right middle PVs and 8 left common trunks) were mapped in 198 patients with paroxysmal AF (PAF) who underwent circumferential PV isolation. cPVB with a mean coupling interval of 136 ± 16 ms during SR was observed prior to ablation in 22 (11%) patients. Focal firing was provoked prior to ablation in 144 (19%) PVs. The incidence of focal firing was greater in PVs exhibiting cPVB compared with PVs without cPVB (89% vs. 16%; < 0.001). Also, the number of radiofrequency applications required for isolation was greater in ipsilateral PVs, exhibiting cPVB compared with ipsilateral PVs without cPVB (21.6 ± 6.8 vs. 18.2 ± 5.6; =0.024). During a follow-up of 32 ± 20 months, the single ablation success rate was 82%. Compared with patients without cPVB, patients with cPVB were associated with higher recurrence rate of AF (27% vs. 17%; =0.032).
cPVB during SR was observed prior to index ablation in 11% of PAF patients. Such a potential itself may be a PV firing in a concealed manner, which does not reactivate LA. The PV exhibiting cPVB required a greater number of radiofrequency applications for isolation. Compared to patients without cPVB, the recurrence rate of AF in patients with cPVB was greater.
在某些心房颤动（AF）患者的窦性心律（SR）期间可能会发现隐匿性肺静脉（PV）二联律（cPVB）。本研究的目的是调查SR期间cPVB的存在是否与较高的PV触发率相关。
对198例行环肺静脉隔离术的阵发性房颤（PAF）患者的776条肺静脉（不包括5条右中叶肺静脉和8条左主干）进行标测。在22例（11%）患者消融术前观察到SR期间平均联律间期为136±16 ms的cPVB。144条（19%）肺静脉在消融术前诱发了局灶性激动。与无cPVB的肺静脉相比，有cPVB的肺静脉局灶性激动的发生率更高（89%对16%；P<0.001）。此外，与同侧无cPVB的肺静脉相比，同侧有cPVB的肺静脉隔离所需的射频应用次数更多（21.6±6.8对18.2±5.6；P=0.024）。在32±20个月的随访期间，单次消融成功率为82%。与无cPVB的患者相比，有cPVB的患者房颤复发率更高（27%对17%；P=0.032）。
在11%的PAF患者索引消融术前观察到SR期间的cPVB。这种潜在因素本身可能是以隐匿方式触发肺静脉，而不会重新激活左心房。表现出cPVB的肺静脉隔离需要更多次数的射频应用。与无cPVB的患者相比，有cPVB的患者房颤复发率更高。
