Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Heart Rhythm. 2019 Apr;16(4):511-519. doi: 10.1016/j.hrthm.2018.10.027. Epub 2018 Oct 26.
Areas of conduction delay (CD) or conduction block (CB) are associated with higher recurrence rates after ablation therapy for atrial fibrillation (AF).
Thus far, there are no reports on the quantification of the extensiveness of CD and CB at the pulmonary vein area (PVA) and their clinical relevance.
Intraoperative high-density epicardial mapping of the PVA (interelectrode distance 2 mm) was performed during sinus rhythm in 268 patients (mean ± SD [minimum-maximum] 67 ± 11 [21-84] years) with and without preoperative AF. For each patient, extensiveness of CD (conduction velocity 17-29 cm/s) and CB (conduction velocity <17 cm/s) was assessed and related to the presence and type of AF.
CD and CB occurred in, respectively, 242 (90%) and 183 (68%) patients. Patients with AF showed a higher incidence of continuous conduction delay and block (CDCB) lines (AF: n = 37 [76%]; no AF: n = 132 [60%]; P = .046), a 2-fold number of lines per patient (CD: 7 [0-30] vs 4 [0-22], P < .001; CB: 3 [0-11] vs 1 [0-12], P = .003; CDCB: 2 [0-6] vs 1 [0-8], P = .004), and a higher incidence of CD or CB lines ≥6 mm and CDCB lines ≥16 mm (P = .011, P = .025, and P = .027). The extensiveness of CD, CB, and CDCB could not distinguish between the different AF types.
Patients with AF more often present with continuous lines of adjacent areas of CD and CB, whereas in patients without AF, lines of CD and CB are shorter and more often separated by areas with normal intra-atrial conduction. However, a considerable overlap in the amount of conduction abnormalities at the PVA was observed between patients with a history of paroxysmal and persistent AF.
在心房颤动（AF）消融治疗后，存在传导延迟（CD）或传导阻滞（CB）区域与更高的复发率相关。
到目前为止，尚无关于肺静脉区域（PVA）CD 和 CB 广泛程度及其临床相关性的量化报告。
在窦性心律下对 268 例（平均 ± SD [最小-最大] 67 ± 11 [21-84]岁）有或无术前 AF 的患者进行 PVA 高密度心外膜标测（电极间距 2mm）。对每位患者，评估 CD（传导速度 17-29cm/s）和 CB（传导速度<17cm/s）的广泛程度，并与 AF 的存在和类型相关。
242 例（90%）和 183 例（68%）患者发生 CD 和 CB。AF 患者连续传导延迟和阻滞（CDCB）线的发生率更高（AF：n=37 [76%]；无 AF：n=132 [60%]；P=0.046），每个患者的线数增加了 2 倍（CD：7[0-30]比 4[0-22]，P<0.001；CB：3[0-11]比 1[0-12]，P=0.003；CDCB：2[0-6]比 1[0-8]，P=0.004），CD 或 CB 线≥6mm 和 CDBC 线≥16mm 的发生率更高（P=0.011，P=0.025，P=0.027）。CD、CB 和 CDBC 的广泛程度不能区分不同的 AF 类型。
AF 患者更常出现相邻 CD 和 CB 区域的连续线，而无 AF 患者的 CD 和 CB 线更短，且更常被正常的房内传导区域隔开。然而，在有阵发性和持续性 AF 病史的患者中，PVA 的传导异常程度存在相当大的重叠。
