Cardioangiologisches Centrum Bethanien (CCB), Wilhelm Epstein-Str. 4, 60431, Frankfurt am Main, Germany.
Dipartimento di Cardiologia, Policlinico Universitario di Padova, Padova, Italy.
J Interv Card Electrophysiol. 2020 Apr;57(3):465-471. doi: 10.1007/s10840-019-00556-5. Epub 2019 May 7.
Durable pulmonary vein isolation (PVI) is the goal of atrial fibrillation (AF) ablation. The endoscopic ablation system (EAS) is associated with a high rate of persistent PVI. The aim of this study was to analyze the incidence and pattern of conduction gaps in patients with arrhythmia recurrence after an EAS-guided PVI.
Repeat ablations after an EAS-guided PVI were analyzed. After PV angiograms, PV reconnection was assessed. Radiofrequency ablation was delivered at the earliest pulmonary vein (PV) activation site (gap) with the goal of PV re-isolation. First, the incidence of reconnected PVs per patient was assessed. Second, the gap pattern according to the individual PV quadrant was analyzed.
Fifty-nine out of 373 (16%) patients underwent a second procedure after index EAS. PV reconnection was observed in 71/230 (31%) PVs without statistically significant differences between individual PVs. A higher incidence of gaps was found for right PVs (49 vs. 27; p 0.0006). The carina between the superior and inferior PV presented a low incidence of gaps (18 vs. 56, p < 0.0001). Gaps were also predominant at the AS segment of the RSPV (11 gaps). No predictors of reconnection were found, except the higher total amount of application in the reconnected right inferior PV (26.03 ± 1.30 vs. 32.04 ± 2.89; p 0.0396).
EAS-guided PVI results in a 72% durable PVI rate in patients with AF recurrences without difference between individual PVs. More of the gap was found in the right PVs especially in the anterosuperior segment of the RSPV.
持久的肺静脉隔离（PVI）是心房颤动（AF）消融的目标。内镜消融系统（EAS）与持续性 PVI 的高发生率相关。本研究旨在分析 EAS 指导的 PVI 后心律失常复发患者中传导间隙的发生率和模式。
分析 EAS 指导的 PVI 后重复消融。在进行 PV 血管造影后，评估 PV 再连接。在最早的肺静脉（PV）激活部位（间隙）进行射频消融，以实现 PV 再隔离。首先，评估每个患者的再连接 PV 数。其次，分析按个体 PV 象限的间隙模式。
373 例患者中有 59 例（16%）在指数 EAS 后进行了第二次手术。在 230 个 PV 中观察到 71 个（31%）PV 再连接，各个 PV 之间没有统计学差异。右 PV 的间隙发生率较高（49 比 27；p 0.0006）。上、下 PV 之间的嵴间隙发生率较低（18 比 56，p<0.0001）。RSPV 的 AS 段也以间隙为主（11 个间隙）。除了再连接的右下 PV 的应用总量较高（26.03±1.30 比 32.04±2.89；p 0.0396）外，未发现再连接的预测因素。
EAS 指导的 PVI 在 AF 复发患者中实现了 72%的持久 PVI 率，各个 PV 之间没有差异。在右 PV 中发现更多的间隙，尤其是在 RSPV 的前上节段。
