Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany.
University Heart Centre Lübeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany.
Europace. 2019 Oct 1;21(10):1494-1501. doi: 10.1093/europace/euz187.
Arrhythmia recurrence is a common clinical problem in patients with pulmonary vein stenosis (PVS) following catheter ablation of atrial fibrillation. The study sought to analyse the management of arrhythmia recurrence in patients with PVS.
Retrospective analysis was performed on 29 patients with high-degree PVS. Follow-up contained clinical visits, Holter-electrocardiogram recordings and invasive pulmonary vein (PV) angiography and electrophysiological studies. Arrhythmia recurrence was observed in 18 patients (62%) after PVS formation. Fifteen of 18 patients (83.3%) with and 1 of 11 patients (9.1%) without arrhythmia recurrence had electrical PV reconnection (P = 0.0003). In 14 of 16 patients repeat pulmonary vein isolation (PVI) was conducted (radiofrequency ablation in 12 and cryoballoon ablation in 2 cases). Repeat PVI was successful in all PVs in nine patients and incomplete in five patients (failed attempt in two patients with stent implantation, no attempt in three patients with stenotic PVs). Freedom from arrhythmia recurrence was estimated at 56.3% [95% confidence interval (CI) 36.4-72.0%] after 24 months. At the end of the follow-up, complete PVI was documented in 19 of 23 patients (82.6%) with stable sinus rhythm and in 2 of 6 patients with arrhythmia recurrence (33.3%) (P = 0.0335). The Kaplan-Meier estimate of recurrence-free survival of restenosis after interventional PVS treatment was similar in patients without and with repeat ablation [75.6% (95% CI 57.0-94.3%) and 67.0% (95% CI 43.2-90.7%) after 500 days, P = 0.77].
Pulmonary vein reconnection is the major driver of arrhythmia recurrence in PVS patients. Repeat PVI is feasible and does not lead to progression of PVS or restenosis if the procedure is carefully performed.
肺静脉狭窄（PVS）患者在行导管消融治疗心房颤动后常出现心律失常复发。本研究旨在分析 PVS 患者心律失常复发的管理方法。
对 29 例高度 PVS 患者进行回顾性分析。随访包括临床访视、动态心电图记录以及有创肺静脉（PV）血管造影和电生理研究。PVS 形成后，18 例患者（62%）出现心律失常复发。18 例心律失常复发患者中，15 例（83.3%）存在电PV 再连接，而 11 例无心律失常复发患者中仅 1 例（9.1%）存在电 PV 再连接（P=0.0003）。16 例患者中有 14 例（87.5%）再次行 PV 隔离（射频消融 12 例，冷冻球囊消融 2 例）。9 例患者所有 PV 再次行 PV 隔离成功，5 例患者不完全成功（2 例支架植入患者尝试失败，3 例狭窄 PV 患者未尝试）。24 个月后，心律失常复发的无复发生存率估计为 56.3%（95%置信区间：36.4%-72.0%）。在随访结束时，19 例窦性心律稳定患者（82.6%）和 6 例心律失常复发患者中的 2 例（33.3%）（P=0.0335）行完全 PV 隔离。无再次消融患者与有再次消融患者的介入治疗后 PVS 再狭窄复发的无复发生存率的 Kaplan-Meier 估计相似[500 天后分别为 75.6%（95%置信区间：57.0%-94.3%）和 67.0%（95%置信区间：43.2%-90.7%），P=0.77]。
电PV 再连接是 PVS 患者心律失常复发的主要驱动因素。如果仔细操作，再次行 PV 隔离是可行的，且不会导致 PVS 进展或再狭窄。
