Ahmed-Jushuf Fiyyaz, Murgatroyd Francis, Dhillon Para, Scott Paul A
Department of Cardiology King's College Hospital NHS Foundation Trust London UK.
J Arrhythm. 2019 Mar 12;35(2):205-214. doi: 10.1002/joa3.12174. eCollection 2019 Apr.
AF ablation (AFA) with pulmonary vein isolation (PVI) is highly successful for paroxysmal atrial fibrillation (PAF). However, success rates for persistent AF (PsAF) are significantly lower. In this study we evaluate the impact of left atrial (LA) low voltage areas (LVA) on response to AFA.
Consecutive patients undergoing first-time radiofrequency AFA were included (n = 160, 53% PAF). PVI was performed followed by LA voltage mapping during sinus rhythm. Patients were categorized as having LVA based on the presence of LVA (0.2-0.5 mV) in the LA assessed visually by the operator intra-procedurally. Further adjunctive LA ablation was performed at the operators' discretion. The end-point was recurrence of any sustained atrial arrhythmia (atrial fibrillation/tachycardia/flutter) during 12 months follow-up.
All patients had PVI and 23 (14%) had adjunctive LA ablation. LVA were found in 49 (31%) patients and were an independent predictor of arrhythmia recurrence. Patients with LVA compared to those without had significantly lower 12-month arrhythmia-free survival in both PAF (38% vs 76%; = 0.002) and PsAF (27% vs 61%; = 0.015). PsAF patients without LVA (93% had PVI alone) had similar arrhythmia-free survival to patients with PAF (61% vs 67%, respectively; = 0.42). Recurrence in patients with LVA compared to those without was more likely to be an organized atrial arrhythmia rather than AF (16/30 recurrences vs 2/26, < 0.001).
The presence of LVA predicts AFA success as well as the type of arrhythmia recurrence. The absence of LVA identifies PsAF patients that respond well to a PVI-based ablation strategy.
采用肺静脉隔离术（PVI）的房颤消融术（AFA）对阵发性房颤（PAF）极为有效。然而，持续性房颤（PsAF）的成功率则显著较低。在本研究中，我们评估了左心房（LA）低电压区（LVA）对AFA反应的影响。
纳入首次接受射频AFA的连续患者（n = 160，53%为PAF）。先进行PVI，然后在窦性心律期间进行LA电压标测。根据术者在术中目视评估LA中LVA（0.2 - 0.5 mV）的存在情况，将患者分类为有LVA。术者可自行决定是否进一步进行辅助性LA消融。终点为12个月随访期间任何持续性房性心律失常（房颤/房性心动过速/房扑）的复发。
所有患者均进行了PVI，23例（14%）进行了辅助性LA消融。49例（31%）患者发现有LVA，且LVA是心律失常复发的独立预测因素。有LVA的患者与无LVA的患者相比，PAF（38%对76%；P = 0.002）和PsAF（27%对61%；P = 0.015）的12个月无心律失常生存率均显著较低。无LVA的PsAF患者（93%仅进行了PVI）与PAF患者的无心律失常生存率相似（分别为61%对67%；P = 0.42）。有LVA的患者与无LVA的患者相比，复发更可能是有组织的房性心律失常而非房颤（30次复发中有16次对26次中有2次，P < 0.001）。
LVA的存在可预测AFA的成功率以及心律失常复发的类型。无LVA可识别出对基于PVI的消融策略反应良好的PsAF患者。
