Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Arrhythmia Center, Fuwai Yunnan Cardiovascular Hospital, Kunming, China.
J Cardiovasc Electrophysiol. 2021 Sep;32(9):2381-2390. doi: 10.1111/jce.15174. Epub 2021 Jul 27.
The effects of epicardial connections (ECs) involving pulmonary veins (PVs) in atrial fibrillation (AF) ablation have been revealed recently. However, no systematic approaches to identify and ablate the ECs were established.
Patients with AF undergoing radiofrequency (RF) catheter ablation were retrospectively analyzed. ECs were identified when (1) PV isolation (PVI) cannot be achieved after first-pass isolation; (2) PVI was still absent although the conduction gap was detected and ablated; (3) the earliest activation area (EAA) was revealed located within the PV antrum distant from the initial ablation line using high-density mapping (HDM) technique; (4) focal ablation at the EAA was effective to achieve PVI. Relevant pacing maneuvers were performed to elucidate ECs' bidirectional conduction.
Overall, 36 ECs were identified and ablated in 35/597 (5.86%) patients. Among the 35 patients with ECs, at least one PV insertion of ECs was located at the carina region. The most common pattern was a single breakthrough in 31 (88.6%) patients, followed by multiple breakthroughs in 3 and wide breakthroughs in 1. The median distance from EAA to the initial ablation line was 10.0 mm. The average number of RF energy delivery was 1.75 ± 1.00, and single RF delivery was adequate in 16/36 (44.4%) patients. Continuous potentials were present at the EAA in 9/34 (26.5%) patients.
ECs were confirmed and ablated successfully in 5.86% (35/597) AF patients using HDM. PV insertions of ECs were mainly located at the carina region. Continuous potentials might assist in the prediction of ECs.
最近揭示了心外膜连接（ECs）在心房颤动（AF）消融中的作用。然而，尚未建立系统的方法来识别和消融 ECs。
回顾性分析接受射频（RF）导管消融的 AF 患者。当出现以下情况时，可识别 ECs：（1）首次隔离后仍无法实现肺静脉（PV）隔离（PVI）；（2）尽管检测到并消融了传导间隙，但仍未出现 PVI；（3）使用高密度标测（HDM）技术，在距离初始消融线较远的 PV 窦内发现最早激活区（EAA）；（4）EAA 处的局灶消融有效实现 PVI。进行相关起搏操作以阐明 ECs 的双向传导。
总体而言，在 35/597（5.86%）例患者中发现并消融了 36 个 ECs。在 35 例存在 ECs 的患者中，至少有一个 ECs 的 PV 插入位于隆嵴区域。最常见的模式是 31 例（88.6%）患者单个突破，3 例多个突破，1 例广泛突破。EAA 至初始消融线的中位数距离为 10.0 mm。RF 能量输送的平均次数为 1.75±1.00，16/36（44.4%）例患者单次 RF 输送即可。9/34（26.5%）例患者的 EAA 存在连续电位。
使用 HDM 在 5.86%（35/597）例 AF 患者中成功确认和消融 ECs。ECs 的 PV 插入主要位于隆嵴区域。连续电位可能有助于预测 ECs。
