Department of Medicine, Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Medicine, Division of Cardiology, Section for Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Heart Rhythm. 2020 Oct;17(10):1740-1744. doi: 10.1016/j.hrthm.2020.05.005. Epub 2020 May 7.
Electrical posterior wall isolation (PWI) is increasingly being used for the treatment of patients with atrial fibrillation (AF). Few data exist on the durability of PWI using current technology.
The purpose of this study was to characterize the frequency and location of posterior wall reconnection at the time of repeat catheter ablation for AF.
We performed a single-center retrospective cohort study of 50 patients undergoing repeat AF ablation after previous PWI. Durability of PWI was assessed at the time of repeat ablation based on posterior wall entrance and exit block. Sites of posterior wall reconnection were characterized based on review of recorded electrical signals and electroanatomic maps.
At the time of repeat ablation, mean age was 67 ± 10 years, 31 of 50 patients had persistent AF, and mean CHADS-VASc score was 3.0 ± 1.8. Of the 50 patients, 30 had durable PWI at repeat ablation, 1.4 ± 1.6 years after the index procedure. Patients with posterior wall reconnection required repeat ablation earlier (0.9 ± 0.6 years vs1.8 ± 1.9 years from index PWI; P = .048) and were more likely to have atypical atrial flutter (55% vs 27%; P = .043). Among patients with posterior wall reconnection, the roof was the most common site of reconnection (14/20), and 12 patients had multiple regions of reconnection noted.
Posterior wall reconnection is noted in 40% of patients undergoing repeat ablation after an index PWI. The roof of the left atrium is the most common site of posterior wall reconnection.
电隔离后壁（PWI）越来越多地用于治疗心房颤动（AF）患者。目前关于使用现有技术的 PWI 持久性的数据很少。
本研究的目的是描述在重复导管消融治疗 AF 时后壁重新连接的频率和位置。
我们对 50 例先前接受过 PWI 的患者进行了单中心回顾性队列研究，以评估重复消融时 PWI 的持久性。根据后壁入口和出口阻滞，在重复消融时评估 PWI 的持久性。根据记录的电信号和电解剖图回顾，对后壁重新连接的部位进行特征描述。
在重复消融时，平均年龄为 67 ± 10 岁，50 例患者中有 31 例持续性 AF，平均 CHADS-VASc 评分为 3.0 ± 1.8。在 50 例患者中，30 例在重复消融时具有持久的 PWI，距指数手术 1.4 ± 1.6 年。后壁重新连接的患者需要更早地进行重复消融（距指数 PWI 0.9 ± 0.6 年 vs 1.8 ± 1.9 年；P =.048），且更可能发生非典型性房性心动过速（55% vs 27%；P =.043）。在后壁重新连接的患者中，房顶是重新连接最常见的部位（14/20），有 12 例患者有多个部位的重新连接。
在接受指数 PWI 后的重复消融中，有 40%的患者出现后壁重新连接。左心房房顶是后壁重新连接的最常见部位。
