Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan.
Section of Electrophysiology/Division of Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan.
Heart Rhythm. 2021 May;18(5):694-701. doi: 10.1016/j.hrthm.2021.01.006. Epub 2021 Jan 9.
Electrical isolation of the left atrial appendage (LAA) improves outcomes of patients with persistent atrial fibrillation (AF) but may increase the risk of thromboembolism.
The purpose of this study was to describe a method to map and ablate appendage drivers without complete electrical isolation.
One hundred thirteen patients underwent an ablation procedure for persistent AF. The procedure was performed during AF and consisted of pulmonary vein and posterior LA isolation as well as ablation of the LAA. The right atrium (RA) was targeted in patients with a right-to-left gradient in cycle length (CL). The end point of appendage ablation was CL slowing or AF termination but not complete isolation.
Among the 113 patients (mean age 64.6 ± 8.6 years; ejection fraction 54% ± 13%; LA diameter 46 ± 6.5 mm), radiofrequency ablation terminated AF in 51 patients (45%). RA ablation was performed in 41 patients (36%) at the index or repeat procedure. The mean AF CL in the RA appendage (RAA) was shorter than that in the LAA (160 ± 32 ms vs 186 ± 29 ms; P < .01) in these patients. The most frequent target in the RA was the RAA (CLs approaching 50-60 ms). Discontinuing radiofrequency ablation upon AF termination or conduction slowing prevented LAA isolation. After a mean follow-up of 24 ± 15 months, 89 patients (78%) remained arrhythmia-free without antiarrhythmic medications.
An ablation strategy guided by the AF CL addresses LAA drivers without complete electrical isolation and also helps identify the RAA as a source of persistent AF.
电隔离左心耳（LAA）可改善持续性心房颤动（AF）患者的预后，但可能增加血栓栓塞风险。
本研究旨在描述一种无需完全电隔离即可对 LAA 进行标测和消融的方法。
113 例持续性 AF 患者行消融术。手术在 AF 期间进行，包括肺静脉和后 LA 隔离以及 LAA 消融。在存在左右心房周长（CL）梯度的患者中，将右心房（RA）作为消融靶点。消融终点为 CL 减慢或 AF 终止，但不要求完全隔离。
113 例患者（平均年龄 64.6 ± 8.6 岁；射血分数 54% ± 13%；LA 直径 46 ± 6.5 mm）中，51 例（45%）患者经射频消融终止 AF。41 例（36%）患者在初次或再次手术中进行 RA 消融。这些患者的 RA 心耳（RAA）的平均 AF CL 短于 LAA（160 ± 32 ms 比 186 ± 29 ms；P <.01）。RA 最常见的靶点是 RAA（接近 50-60 ms 的 CLs）。在 AF 终止或传导减慢时停止射频消融可防止 LAA 隔离。平均随访 24 ± 15 个月后，89 例（78%）患者无心律失常且无需抗心律失常药物。
一种以 AF CL 为指导的消融策略可治疗 LAA 驱动因素，而无需完全电隔离，还可帮助识别 RAA 为持续性 AF 的来源。
