Yoshida Akihiro, Takami Kaoru, Yamada Shinichiro, Yamawaki Kohei, Tagashira Toru, Hiraishi Mana, Terashita Daisuke, Tsuda Shigeyasu, Nakamura Koichi, Fujita Ayaka, Naniwa Shota, Awano Kojiro, Kiuchi Kunihiko, Fukuzawa Koji, Hirata Ken-Ichi
Department of Cardiology, Kita-Harima Medical Center Ono Japan.
Section of Arrhythmia Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine Kobe Japan.
Circ Rep. 2019 Apr 18;1(5):206-211. doi: 10.1253/circrep.CR-19-0002.
In persistent AF, the effect of adjunctive ablation in addition to PV isolation (PVI) is controversial. We considered a new modified PVI including complex fractionated atrial electrogram (CFAE) area. In 57 patients with persistent AF undergoing first ablation, CFAE were mapped before ablation and CFAE-guided extensive encircling PVI (CFAE-guided EEPVI) was performed. The PVI line was designed to include the CFAE area near PV or to cross the minimum cycle length points of the CFAE area near PV (CFAE-guided EEPVI group). The outcome was compared with conventional PVI in 34 patients with persistent AF (conventional PVI group). During a mean follow-up of 365±230 days after the first procedure, AF in 13 and atrial tachycardia (AT) in 9 patients recurred in the CFAE-guided EEPVI group, while only AF in 17 patients recurred in the conventional PVI group. Eight of 9 AT in the CFAE-guided EEPVI group were successfully ablated at second procedure. After first and second procedures, the recurrence of atrial tachyarrhythmia in the CFAE-guided EEPVI group was significantly reduced compared with the conventional PVI group (8 patients, 14% vs. 11 patients, 32%, respectively; P<0.01, log-rank test). CFAE-guided EEPVI was more effective for persistent AF compared with conventional PVI after first and second procedures, because recurring AT as well as re-conduction of PV was successfully ablated.
在持续性房颤中，除肺静脉隔离（PVI）外辅助消融的效果存在争议。我们考虑了一种新的改良PVI，包括复杂碎裂心房电图（CFAE）区域。对57例接受首次消融的持续性房颤患者，在消融前绘制CFAE图，并进行CFAE引导的广泛环绕PVI（CFAE引导的EEPVI）。PVI线设计为包括肺静脉附近的CFAE区域或穿过肺静脉附近CFAE区域的最短周期长度点（CFAE引导的EEPVI组）。将结果与34例持续性房颤患者的传统PVI进行比较（传统PVI组）。在首次手术后平均365±230天的随访期间，CFAE引导的EEPVI组有13例房颤复发，9例房性心动过速（AT）复发，而传统PVI组仅有17例房颤复发。CFAE引导的EEPVI组9例AT中有8例在第二次手术时成功消融。在第一次和第二次手术后，CFAE引导的EEPVI组房性快速心律失常的复发率与传统PVI组相比显著降低（分别为8例，14%对11例，32%；P<0.01，对数秩检验）。与传统PVI相比，CFAE引导的EEPVI在第一次和第二次手术后对持续性房颤更有效，因为复发性AT以及肺静脉的再传导均被成功消融。
