肺静脉隔离后复发性房颤诱发性的演变：肺静脉外基质进展的电生理证据。
Evolution of post-pulmonary vein isolation atrial fibrillation inducibility at redo ablation: Electrophysiological evidence of extra-pulmonary vein substrate progression.
机构信息
Cardiology Division, Geneva University Hospitals, Geneva, Switzerland.
Cardiology Division, Geneva University Hospitals, Geneva, Switzerland.
出版信息
Heart Rhythm. 2019 Aug;16(8):1160-1166. doi: 10.1016/j.hrthm.2019.02.026. Epub 2019 Feb 25.
BACKGROUND
The electrophysiological substrate underlying atrial fibrillation (AF) progression remains difficult to identify.
OBJECTIVE
The goals of this study were to study the evolution of post-pulmonary vein isolation (PVI) AF inducibility (AFI) after AF ablation and to compare patients with organized atrial tachycardia recurrence (OATr) versus those with paroxysmal or persistent AF recurrence.
METHODS
We studied 99 patients who underwent de novo AF ablation (p1) and redo ablation (p2) for AF recurrence (AFr) or OATr. Stepwise AF ablation was performed at p1 and p2: (1) PVI, (2) coronary sinus defragmentation, and (3) left atrial (LA) defragmentation. Burst pacing followed each step, with AFI defined as sustained AF >5 minutes, triggering the next step. Patients with OATr underwent OAT ablation and inducibility testing post-redo PVI. Inducibility progression (IP) was defined as AFI at further steps of p2 compared to p1.
RESULTS
Among patients with AFr, 34 of 72 patients (47%) exhibited post-PVI IP vs 2 of 27 (7.4%) patients with OATr (P = .0002). Stratification for persistent AF/paroxysmal AF/OATr showed a consistent association between recurrence phenotype and IP. Pulmonary vein (PV) reconnection incidence was 90%, without association with recurrence type or IP. LA volume was larger in patients with IP than in those without IP (86.7 ± 25.3 mL vs 72.0 ± 28.9 mL; P = .001). Right atrial dimensions increased between p1 and p2 in patients with IP vs no IP and in patients with AFr vs OATr.
CONCLUSION
Patients with AFr after first ablation exhibit IP more frequently at redo ablation than do patients with OATr. IP correlates with more advanced AFr type, larger LA volumes, and progressive right atrial enlargement. PV reconnection is not associated with AFr. Changes in post-PVI AFI may accurately indicate progression of extra-PV AF-maintaining substrate.
背景
心房颤动（AF）进展的电生理基础仍难以确定。
目的
本研究旨在研究 AF 消融后肺静脉隔离（PVI）后 AF 诱发性（AFI）的演变，并比较伴有有组织性房性心动过速复发（OATr）与阵发性或持续性 AF 复发的患者。
方法
我们研究了 99 例因 AF 复发（AFr）或 OATr 而首次行 AF 消融（p1）和再次消融（p2）的患者。在 p1 和 p2 时逐步进行 AF 消融：（1）PVI，（2）冠状窦碎裂，（3）左心房（LA）碎裂。每次步骤后进行 burst 起搏，定义持续 AF >5 分钟的 AFI 触发下一步骤。OATr 患者在 redo PVI 后进行 OAT 消融和诱发性测试。定义 AFI 进展（IP）为 p2 较 p1 的进一步步骤。
结果
在 AFr 患者中，72 例患者中有 34 例（47%）表现出 PVI 后 IP，而 27 例患者中有 2 例（7.4%）有 OATr（P=0.0002）。对持续性 AF/阵发性 AF/OATr 的分层显示，复发表型与 IP 之间存在一致的关联。肺静脉（PV）再连接发生率为 90%，与复发类型或 IP 无关。有 IP 的患者的 LA 体积大于无 IP 的患者（86.7±25.3 mL 比 72.0±28.9 mL；P=0.001）。在有 IP 和无 IP 的患者中，在 p1 和 p2 之间右心房大小增加，在有 AFr 和 OATr 的患者中也是如此。
结论
首次消融后的 AFr 患者在再次消融时更频繁地出现 IP，而 OATr 患者则不然。IP 与更严重的 AFr 类型、更大的 LA 体积和进行性右心房增大相关。PV 再连接与 AFr 无关。PVI 后 AFI 的变化可能准确指示 PV 外 AF 维持基质的进展。
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