LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux-Pessac, France.
J Cardiovasc Electrophysiol. 2020 Jul;31(7):1640-1648. doi: 10.1111/jce.14576. Epub 2020 Jun 1.
No study to date has used high-density mapping to investigate the relationship between prior radiofrequency (RF) lesions for persistent atrial fibrillation (PsAF) ablation and subsequent atrial tachycardias (ATs).
From 41 consecutive patients who underwent AT ablation at a second procedure using an ultrahigh-density mapping system, 22 patients (38 ATs) were included as they also had complete maps with a multipolar catheter and three-dimensional (3D) mapping system at the time of the first PsAF ablation procedure. We, therefore, compared voltage maps from the first AF ablation procedure to those from the subsequent AT ablation procedure, as well as the lesion sets used for AF ablation vs the activation patterns in AT during the second procedure.
In the 38 ATs, 211 of 285 analyzed atrial areas displayed low voltage area (LVA) (74%). Eighteen percent (38/211) existed before the index ablation for AF while 82% (173/211) were newly identified as LVA during the second procedure. Ninety-nine percent (172/173) of the newly developed LVA colocalized with RF lesions delivered for PsAF. Of the 38 ATs, 89.5% (34/38) AT circuits were associated with newly developed LVA due to RF lesions whilst 10.5% (4/38) AT circuits were associated with pre-existing LVA observed at the index procedure. No AT circuit was completely independent from index RF lesions in this series.
Analysis of detailed 3D electroanatomical mapping demonstrates that most ATs after PsAF ablation are involving LVAs due to index RF lesions.
目前尚无研究使用高密度标测来研究持续性心房颤动（PsAF）消融的先前射频（RF）损伤与随后的房性心动过速（AT）之间的关系。
从 41 例连续接受第二次 AT 消融的患者中，有 22 例（38 个 AT）入选，因为他们在首次 PsAF 消融手术时也使用多极导管和三维（3D）标测系统进行了完整的标测。因此，我们比较了第一次 AF 消融手术的电压图与第二次 AT 消融手术的电压图，以及用于 AF 消融的病变集与第二次手术中 AT 的激活模式。
在 38 个 AT 中，285 个分析心房区域中有 211 个显示低电压区（LVA）（74%）。18%（38/211）在 AF 指数消融之前存在，而 82%（173/211）在第二次手术中被新认定为 LVA。新出现的 LVA 与用于 PsAF 的 RF 损伤的 99%（172/173）重合。在 38 个 AT 中，由于 RF 损伤导致的新出现的 LVA 与 89.5%（34/38）的 AT 环相关，而由于在指数程序中观察到的预先存在的 LVA 与 10.5%（4/38）的 AT 环相关。在这个系列中，没有一个 AT 环完全独立于指数 RF 损伤。
详细的 3D 电解剖标测分析表明，PsAF 消融后大多数 AT 涉及到由于指数 RF 损伤导致的 LVA。
