Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Otorhinolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Clin Cardiol. 2021 Jul;44(7):938-945. doi: 10.1002/clc.23617. Epub 2021 Jun 1.
Catheter ablation has emerged as a major strategy for paroxysmal atrial fibrillation (PAF). Atrial electrical remodeling (AER) plays a critical role in the recurrence of PAF after ablation.
To characterize the immediate trends of AER during ablations in patients with PAF, and assess the relationship between immediate trends and recurrence.
We performed this prospective observational study of 135 patients to investigate AER following three ablation modes: radiofrequency ablation (RFA), cryoablation (CA) and 3D mapping-guided cryoablation (3D-CA). The atrial effective refractory period (AERP) and atrial conduction time (ACT) were measured via electrophysiology before and immediately after ablation, and P-wave indices were measured via electrocardiography before and within 24 h after ablation. Follow-up visits were conducted for at least 1 year or until relapse.
Different approaches of ablation caused a fairly significant increase in the shortest P-wave duration and AERP in both the proximal coronary sinus (PCS) and distal coronary sinus (DCS) but caused a shortened P-wave dispersion. No different effect was found at the AERP among the three modes. Compared to patients who received CA, among patients who received RFA, a significant reduction in total ACT and right ACT was seen. Statistically, there was a weakly positive association between changes in total ACT and early recurrence.
Injury during ablation for PAF was associated with an increase in the AERP but not in the ACT. Total ACT and right ACT were shorter after RFA than after CA. The increase in total ACT were slightly predictive of early recurrence.
导管消融已成为阵发性心房颤动（PAF）的主要策略。心房电重构（AER）在消融后 PAF 的复发中起着关键作用。
描述 PAF 患者消融过程中 AER 的即时趋势，并评估即时趋势与复发之间的关系。
我们对 135 例患者进行了这项前瞻性观察性研究，以研究三种消融模式（射频消融（RFA）、冷冻消融（CA）和 3D 图谱引导冷冻消融（3D-CA））后 AER 的变化。在消融前和消融后即刻通过电生理测量心房有效不应期（AERP）和心房传导时间（ACT），并在消融前和消融后 24 小时内通过心电图测量 P 波指数。随访时间至少为 1 年或直至复发。
不同的消融方法导致近段冠状窦（PCS）和远段冠状窦（DCS）的最短 P 波持续时间和 AERP 显著增加，但 P 波离散度缩短。三种模式之间 AERP 无明显差异。与接受 CA 的患者相比，接受 RFA 的患者总 ACT 和右 ACT 显著缩短。总 ACT 的变化与早期复发之间存在弱正相关。
PAF 消融过程中的损伤与 AERP 的增加而不是 ACT 的增加有关。RFA 后总 ACT 和右 ACT 较 CA 短。总 ACT 的增加略能预测早期复发。
