Kumagai Koichiro, Toyama Hideko, Zhang Bo
Heart Rhythm Center Fukuoka Sanno Hospital Fukuoka Japan.
International University of Health and Welfare Otawara Japan.
J Arrhythm. 2019 Feb 15;35(2):197-204. doi: 10.1002/joa3.12169. eCollection 2019 Apr.
Previous studies reported that ablation of low-voltage areas (LVAs) after pulmonary vein isolation (PVI) improves the success rate in persistent atrial fibrillation (PerAF) patients with LVAs. However, the need for LVA ablation in addition to the posterior left atrial isolation, Box isolation (BOXI), for PerAF is unclear. We evaluated the effects of LVA ablation after BOXI for PerAF with LVAs.
In 115 patients with PerAF (75 longstanding PerAF), LA voltage maps were created during sinus rhythm after PVI. Subsequently, BOXI was performed. In 61 patients without LVAs (<0.5 mV), BOXI alone was performed. Fifty-four patients with LVAs were randomly assigned to BOXI plus LVA ablation (33 patients) or BOXI alone (21 patients).
The rate of AF termination or cardioversion after BOXI was significantly higher than that after PVI (100% vs 88%, < 0.001). The inducibility of atrial tachyarrhythmia after BOXI was significantly lower than that after PVI (27% vs 100%, < 0.001). During 24 ± 9 months of follow-up after a single procedure, atrial tachyarrhythmia-free rate in the patients with LVAs, was significantly lower than that without LVAs (65% vs 82%, = 0.043). However, the success rate was not significantly different between the BOXI plus LVA ablation group and the BOXI alone group of patients with LVAs (67% vs 62%, = 0.722).
BOXI facilitates AF termination and its non-inducibility. Among patients with PerAF, BOXI alone may be adequate in cases without LVAs. Although cases with LVAs have higher risk of AF recurrence, additional LVA ablation does not improve the outcomes much.
既往研究报道，肺静脉隔离（PVI）后消融低电压区（LVA）可提高持续性房颤（PerAF）合并LVA患者的成功率。然而，对于PerAF患者，除了左房后壁隔离、Box隔离（BOXI）外，是否需要进行LVA消融尚不清楚。我们评估了BOXI后对合并LVA的PerAF患者进行LVA消融的效果。
115例PerAF患者（75例为长期持续性PerAF），在PVI后的窦性心律期间创建左房电压图。随后进行BOXI。61例无LVA（<0.5 mV）的患者仅进行BOXI。54例有LVA的患者被随机分为BOXI联合LVA消融组（33例）或仅BOXI组（21例）。
BOXI后房颤终止或复律的发生率显著高于PVI后（100%对88%，P<0.001）。BOXI后房性快速心律失常的诱发率显著低于PVI后（27%对100%，P<0.001）。在单次手术后24±9个月的随访期间，有LVA患者的无房性快速心律失常率显著低于无LVA患者（65%对82%，P=0.043）。然而，有LVA患者的BOXI联合LVA消融组与仅BOXI组的成功率无显著差异（67%对62%，P=0.722）。
BOXI有助于房颤终止及其不可诱发性。在PerAF患者中，无LVA的情况下仅BOXI可能就足够了。虽然有LVA的患者房颤复发风险较高，但额外的LVA消融并不能显著改善预后。
