Heart Rhythm Center, Fukuoka Sanno Hospital, International University of Health and Welfare.
Department of Cardiovascular Medicine, Shiga University of Medical Science.
Circ J. 2020 Feb 25;84(3):419-426. doi: 10.1253/circj.CJ-19-0826. Epub 2020 Feb 13.
Additional benefits of posterior left atrial (LA) box isolation (BOXI) over pulmonary vein isolation (PVI) in persistent atrial fibrillation (perAF) have been reported, but the mechanism is still unclear. We evaluated the effects of BOXI on rotors and multiple wavelets in the whole LA.
Twenty patients with perAF (including 12 cases of longstanding perAF) underwent PVI. Real-time phase mapping (ExTRa Mapping) was performed in the whole LA during AF. Subsequently, BOXI was added and re-ExTRa Mapping was performed again at the same site. The nonpassively activated ratio (%NP), the ratio of the form of rotors and multiple wavelets to the recording time, was compared before and after BOXI. After BOXI, the %NP significantly decreased in the anterior wall (from 53±22% to 39±23%, P=0.010), inferior wall (from 51±16% to 34±19%, P=0.001), and LA appendage (from 23±27% to 16±19%, P=0.049). However, there were no significant differences in the septum (49±19% vs. 49±18%, P=0.562) or lateral wall (41±19% vs. 38±15%, P=0.526).
BOXI not only reduced the critical mass for maintenance of AF, but also decreased the rotors and multiple wavelets in the anterior wall, inferior wall and LA appendage during perAF.
已有研究报道，相较于肺静脉隔离（PVI），持续性心房颤动（perAF）患者行左心房后壁（LA）BOX 隔离（BOXI）有额外获益，但机制尚不清楚。我们评估了 BOXI 对整个左心房内转子和多个波前的影响。
20 例 perAF 患者（包括 12 例长程 perAF）接受了 PVI。在 AF 期间，在整个左心房进行实时相位图（ExTRa Mapping）。随后，添加 BOXI 并在同一部位再次进行 re-ExTRa Mapping。比较 BOXI 前后非被动激活比例（%NP），即转子和多个波前的形态与记录时间的比值。BOXI 后，前壁（从 53±22%降至 39±23%，P=0.010）、下壁（从 51±16%降至 34±19%，P=0.001）和左心耳（从 23±27%降至 16±19%，P=0.049）的%NP 显著降低。然而，中隔（49±19%比 49±18%，P=0.562）或侧壁（41±19%比 38±15%，P=0.526）无显著差异。
BOXI 不仅减少了维持 AF 的临界质量，而且还减少了 perAF 期间前壁、下壁和左心耳中的转子和多个波前。
