肺静脉隔离术后消融与低电压区重叠的高优势频率部位对非阵发性心房颤动的影响。
Effect of ablation at high-dominant frequency sites overlapping with low-voltage areas after pulmonary vein isolation of nonparoxysmal atrial fibrillation.
机构信息
Department of Cardiovascular Medicine, Tohoku Medical and Pharmaceutical University, Miyagi, Japan.
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan.
出版信息
J Cardiovasc Electrophysiol. 2019 Oct;30(10):1850-1859. doi: 10.1111/jce.14090. Epub 2019 Aug 6.
BACKGROUND
The relationship between high-dominant frequency (DF) sites and low-voltage areas (LVAs) in nonparoxysmal atrial fibrillation (AF) patients still remains unknown.
OBJECTIVE
This study aimed to evaluate the effect of ablation at high-DF sites overlapping with LVAs after pulmonary vein ablation (PVI) of nonparoxysmal AF.
METHODS
A total of 128 consecutive nonparoxysmal patients with atrial fibrillation (53 persistent AF) were retrospectively investigated. The patients with AF were divided into two groups: patients with circumferential PVI alone (PVI group, n = 57) and those with PVI followed by a DF-based ablation (DF group, n = 71).
RESULTS
The patient characteristics did not significantly differ between the two groups. However, the LVA ( < 0.5 mV)/left atrial (LA) surface was significantly greater in the DF than the PVI group (22% vs 16%, P = .02). The total max-DF sites overlapping with LVAs in the LA were significantly greater in the DF than the PVI group (91% vs 10%, P = .001). The atrial arrhythmia freedom on antiarrhythmic drugs in the DF group was significantly greater than that in the PVI group during 10.0 ± 3.2 months of follow-up (83.1% vs 64.9%, log-rank test P = .021). The event-free survival in the PVI group decreased according to the LVA extent while it was > 80% in the DF group. The event-free survival in patients with AF especially with extensive LVAs ( ≥ 30%) in the DF group was significantly greater than that in the PVI group (81.0% vs 45.5%, log-rank test P = .035).
CONCLUSIONS
High-DF sites overlapping with LVAs after the PVI may be potential selective targets for modification of atrial substrates in nonparoxysmal AF patients.
背景
非阵发性心房颤动（AF）患者中高频（DF）部位与低电压区（LVA）之间的关系尚不清楚。
目的
本研究旨在评估非阵发性 AF 患者在行肺静脉消融（PVI）后消融 DF 部位重叠 LVAs 的效果。
方法
回顾性分析了 128 例连续的非阵发性 AF 患者（53 例持续性 AF）。将 AF 患者分为两组：单纯 PVI 组（PVI 组，n=57）和 PVI 后行 DF 消融组（DF 组，n=71）。
结果
两组患者的特征无显著差异。然而，DF 组的 LVA（<0.5 mV）/左心房（LA）面积明显大于 PVI 组（22% vs 16%，P=0.02）。DF 组的总最大 DF 部位与 LA 中的 LVA 重叠明显大于 PVI 组（91% vs 10%，P=0.001）。DF 组的抗心律失常药物治疗后的房性心律失常无效率明显高于 PVI 组（83.1% vs 64.9%，log-rank 检验 P=0.021）。PVI 组的无事件生存率随着 LVA 范围的增大而降低，而 DF 组的无事件生存率则>80%。DF 组中 AF 患者，特别是 LVA 广泛（≥30%）的患者，无事件生存率明显高于 PVI 组（81.0% vs 45.5%，log-rank 检验 P=0.035）。
结论
PVI 后 DF 部位与 LVA 重叠可能是改善非阵发性 AF 患者心房基质的潜在选择性靶点。
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