Department of Cardiology, Beijing Anzhen Hospital Affliated to Capital Medical University, Beijing, China.
Department of Cardiology, Beijing Anzhen Hospital Affliated to Capital Medical University, Beijing, China.
Am J Cardiol. 2020 Jun 15;125(12):1845-1850. doi: 10.1016/j.amjcard.2020.03.030. Epub 2020 Apr 3.
Recurrence of paroxysmal atrial fibrillation (AF) is partly due to pulmonary vein (PV) reconnection and non-PV foci, especially superior vena cava (SVC). We aimed to investigate the efficacy and safety of empiric SVC isolation plus PV isolation after first failed radiofrequency ablation involving only PV isolation for paroxysmal AF. Procedural and follow-up outcomes of ablation for 144 consecutive paroxysmal AF patients after first failed radiofrequency ablation involving only PV isolation were retrospectively compared between patients undergoing either conventional SVC isolation (additional SVC isolation if SVC-triggered AF or rapid SVC activity was observed; n = 72) or empiric SVC isolation after PV isolation (n = 72). In conventional SVC isolation versus empiric SVC isolation groups: baseline characteristics and proportion of recorded PV electrical potentials were similarly distributed and all pulmonary veins were successfully reisolated; SVC isolation was performed less often (6 [8.3%] vs 70 [97.2%]; p <0.001, respectively); and during 19 ± 10 months follow-up, atrial tachyarrhythmias recurrence-free rate after a second procedure was lower (58.3% vs 77.8%, log rank; p = 0.037). Multivariate regression analysis revealed LA diameter ≥45 mm (odds ratio [OR] = 2.5; 95% confidence interval [CI], 1.4 to 4.6; p = 0.002) as the independent risk factor of atrial tachyarrhythmias recurrence and empiric SVC isolation (OR = 0.47; 95% CI, 0.25 to 0.87; p = 0.016) as the independent protector against atrial tachyarrhythmias recurrence after a second ablation procedure. Empiric SVC isolation plus PV isolation did not increase significantly procedural time or complications. In conclusion, the strategy of empiric SVC isolation plus PV isolation during a second procedure for paroxysmal AF improved atrial tachyarrhythmias recurrence-free rate without increasing procedural time or complications.
阵发性心房颤动（AF）的复发部分是由于肺静脉（PV）再连接和非 PV 灶，特别是上腔静脉（SVC）。我们旨在研究在首次仅行 PV 隔离的阵发性 AF 射频消融失败后，经验性 SVC 隔离加 PV 隔离的疗效和安全性。回顾性比较了 144 例首次仅行 PV 隔离的阵发性 AF 患者在射频消融失败后行两种消融策略的临床及随访结果：一种是常规 SVC 隔离（如果观察到 SVC 触发 AF 或 SVC 快速活动，则加行 SVC 隔离；n=72），另一种是 PV 隔离后行经验性 SVC 隔离（n=72）。在常规 SVC 隔离组与经验性 SVC 隔离组中：基线特征和记录的 PV 电活动比例相似，所有肺静脉均成功再隔离；SVC 隔离的发生率较低（6[8.3%] vs 70[97.2%]；p<0.001）；在 19±10 个月的随访期间，第二次手术后房性快速心律失常无复发率较低（58.3% vs 77.8%，对数秩检验；p=0.037）。多变量回归分析显示左心房直径≥45mm（优势比[OR]为 2.5；95%置信区间[CI]为 1.4 至 4.6；p=0.002）是房性快速心律失常复发的独立危险因素，经验性 SVC 隔离（OR=0.47；95%CI 为 0.25 至 0.87；p=0.016）是第二次消融术后房性快速心律失常复发的独立保护因素。经验性 SVC 隔离加 PV 隔离并未显著增加手术时间或并发症。总之，在第二次阵发性 AF 射频消融中采用经验性 SVC 隔离加 PV 隔离策略可提高房性快速心律失常无复发率，而不增加手术时间或并发症。
