碎裂延迟钆增强区指导持续性心房颤动患者导管消融的可行性。
Feasibility of catheter ablation in patients with persistent atrial fibrillation guided by fragmented late-gadolinium enhancement areas.
机构信息
Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Radiology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
出版信息
J Cardiovasc Electrophysiol. 2021 Apr;32(4):1014-1023. doi: 10.1111/jce.14925. Epub 2021 Feb 10.
BACKGROUND
A computer simulation model has demonstrated that atrial fibrillation (AF) driver can be attached to heterogeneous fibrosis assessed by late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, it has not been well elucidated in patients with persistent AF. The aim of this study was to investigate whether radiofrequency (RF) applications in the fragmented LGE area (FLA) could terminate AF or convert it to atrial tachycardia (AT) and improve the rhythm outcome.
METHODS
A total of 31 consecutive persistent AF patients with FLAs were enrolled (FLA ablation group, mean age: 69 ± 8 years, mean left atrial diameter: 42 ± 6 mm). A favorable response was defined as direct AF termination or AT conversion during RF applications at the FLA. The rhythm outcome was compared between the FLA ablation group and FLA burden-matched pulmonary vein isolation (PVI) group.
RESULTS
Favorable responses were found in 15 (48%) of 31 patients in the FLA group (AF termination in seven, AT conversion in eight patients), but not in the PVI group. AF recurrence at 12 months follow-up was significantly less in the FLA ablation group than in the PVI group (4 [13%] vs. 12 [39%] of 31 patients, log-rank p = .023). In patients with a favorable response, AT recurred in 1 (7%) of 15 patients, but AF did not.
CONCLUSIONS
FLA ablation could terminate AF or convert it to AT in half of the patients. No AF recurrence was documented in patients with a favorable response.
背景
计算机模拟模型表明，心房颤动（AF）的驱动灶可以附着于磁共振延迟钆增强成像（LGE-MRI）评估的混杂性纤维化。然而，这在持续性 AF 患者中尚未得到很好的阐明。本研究旨在探讨射频（RF）消融碎裂 LGE 区（FLA）是否能终止 AF 或转为房性心动过速（AT），并改善节律转归。
方法
共纳入 31 例连续的持续性 AF 伴 FLA 患者（FLA 消融组，平均年龄：69±8 岁，平均左心房直径：42±6mm）。RF 消融在 FLA 区时，如果能直接终止 AF 或转为 AT，则定义为有良好反应。比较 FLA 消融组与 FLA 负荷匹配的肺静脉隔离（PVI）组的节律转归。
结果
在 FLA 消融组的 31 例患者中，有 15 例（48%）有良好反应（7 例 AF 终止，8 例转为 AT），但 PVI 组无此反应。在 12 个月的随访中，FLA 消融组的 AF 复发率明显低于 PVI 组（4[13%]例比 12[39%]例，log-rank p=0.023）。在有良好反应的患者中，15 例中的 1 例（7%）出现 AT 复发，但无 AF 复发。
结论
FLA 消融能使一半的患者 AF 终止或转为 AT。有良好反应的患者无 AF 复发。
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