Ioannidis P, Zografos T, Vassilopoulos C, Christoforatou E, Kouvelas K, Kappou T, Dadous G, Skeberis V, Fragakis N, Vassilikos V, Sakadamis G, Kanonidis I
Heart Rhythm Center, Athens Bioclinic, Athens, Greece.
Second Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Interv Card Electrophysiol. 2021 Apr;60(3):493-511. doi: 10.1007/s10840-020-00759-1. Epub 2020 May 13.
A possible consequence of atrial fibrillation (AF) ablation is the occurrence of organized atrial tachycardias (ATs). ATs after AF ablation (ATAAF) may be more symptomatic than AF itself, thus necessitating catheter ablation. We evaluated the prognostic significance of clinical and invasive characteristics for long-term sinus rhythm (SR) maintenance following ATAAF ablation and assessed the effect of technological developments on these results.
Fifty-six consecutive patients with symptomatic ATAAF participated in the study and 114 ATAAF were revealed (2.04 ± 0.93 per patient). Sixty-eight ATAAF (60%) were macroreentrant and 33 (29%) were microreentrant circuits, while 13 (11%) were focal automatic tachycardias. The mean follow-up was 40 ± 18 months with 34 (61%) patients maintaining SR. Treatment with contact force (CF) catheters and EnSite AutoMap module (n = 11) showed significantly better AT/AF free rates at 1-year follow-up (10/11, 91%) compared with treatment using CF catheters but not AutoMap module (n = 13) (8/13, 62%) and treatment with use of neither of these modalities (n = 32) (16/32, 50%). Among patients with macroreentrant circuits around the mitral annulus or left atrial roof (n = 38), the group treated with complete linear lesions in anatomical isthmuses (n = 25) showed significantly better SR maintenance (19/25, 76%) compared with patients (n = 13) treated by empirical ablation in critical functional areas (6/13, 46%).
Technology advancement contributes substantially to long-term success in SR maintenance, by achieving detailed mapping and more effective ablation of ATAAF. The targeting of macroreentrant circuits by creating anatomical linear lesions appears to provide better results.
心房颤动（AF）消融的一个可能后果是发生有组织的房性心动过速（ATs）。AF消融术后的ATs（ATAAF）可能比AF本身症状更明显，因此需要进行导管消融。我们评估了临床和有创特征对ATAAF消融后长期窦性心律（SR）维持的预后意义，并评估了技术发展对这些结果的影响。
56例有症状的ATAAF连续患者参与了本研究，共发现114次ATAAF（每位患者2.04±0.93次）。68次ATAAF（60%）为大折返性，33次（29%）为微折返环，13次（11%）为局灶性自动性心动过速。平均随访40±18个月，34例（61%）患者维持窦性心律。与仅使用接触力（CF）导管但未使用EnSite AutoMap模块（n = 13）（8/13，62%）以及未使用这两种方式（n = 32）（16/32，50%）的治疗相比，使用CF导管和EnSite AutoMap模块治疗（n = 11）在1年随访时显示出显著更好的无AT/AF率（10/11，91%）。在二尖瓣环或左心房顶部周围有大折返环的患者中（n = 38），在解剖峡部进行完全线性病变治疗的组（n = 25）与在关键功能区域进行经验性消融治疗的患者（n = 13）相比，窦性心律维持情况显著更好（19/25，76%）（6/13，46%）。
技术进步通过实现对ATAAF的详细标测和更有效的消融，对长期维持窦性心律的成功做出了重大贡献。通过创建解剖线性病变来靶向大折返环似乎能提供更好的结果。
