Xie Xin, Yang Gang, Li Xiaorong, Yu Jinbo, Zhang Fengxiang, Ju Weizhu, Chen Hongwu, Li Mingfang, Gu Kai, Cheng Dian, Wang Xuecheng, Wu Yizhang, Zhou Jian, Zhou Xiaoqian, Zhang Baowei, Kojodjojo Pipin, Cao Kejiang, Yang Bing, Chen Minglong
Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Front Cardiovasc Med. 2021 Jul 20;8:690297. doi: 10.3389/fcvm.2021.690297. eCollection 2021.
Pulmonary vein isolation (PVI) is an effective strategy in the treatment of paroxysmal atrial fibrillation (PAF). Yet, there are limited data on additional ablation beyond PVI. In this study, we sought to assess the prevalence, predictors, and outcomes of additional ablation in PAF patients. A total of 537 consecutive patients with PAF were retrospectively evaluated for the index procedure. PVI was successfully conducted in all patients, after which electrophysiological study and drug provocation were performed, and additional ablations were delivered for concomitant arrhythmias, non-PV triggers, and low voltage zone (LVZ). The prevalence, predictors, and outcomes of additional ablation were analyzed. Among 537 consecutive patients, 372 addition ablations were performed in 241 (44.88%) patients, including 252 (67.74%) concomitant arrhythmias in 198 (36.87%) patients, 56 (15.05%) non-PV triggers in 52 (9.68%) patients and 64 (17.20%) LVZ modification in 47 (8.75%) patients. Lower LVEF (OR = 0.937, = 0.015), AF episode before procedure (OR = 2.990, = 0.001), AF episode during procedure (OR = 1.998, = 0.002) and AF episode induced after PVI (OR = 15.958, < 0.001) were independent predictors of additional ablation. Single-procedure free from atrial arrhythmias at 58.36 ± 7.12 months post-ablation was 70.48%. Additional ablations were common in patients with PAF for index procedure. Lower LVEF and AF episodes before, during the procedure, and induced after PVI predicts additional ablation.
肺静脉隔离术（PVI）是治疗阵发性心房颤动（PAF）的一种有效策略。然而，关于PVI之外的额外消融的数据有限。在本研究中，我们试图评估PAF患者额外消融的发生率、预测因素及结果。对537例连续的PAF患者进行了回顾性评估，以分析其初次手术情况。所有患者均成功进行了PVI，之后进行了电生理检查和药物激发试验，并针对合并的心律失常、非肺静脉触发灶和低电压区（LVZ）进行了额外消融。分析了额外消融的发生率、预测因素及结果。在537例连续患者中，241例（44.88%）患者进行了372次额外消融，其中198例（36.87%）患者出现252次（67.74%）合并心律失常，52例（9.68%）患者出现56次（15.05%）非肺静脉触发灶，47例（8.75%）患者出现64次（17.20%）LVZ改良。较低的左心室射血分数（LVEF）（OR = 0.937，P = 0.015）、术前房颤发作（OR = 2.990，P = 0.001）、术中房颤发作（OR = 1.998，P = 0.002）以及PVI后诱发的房颤发作（OR = 15.958，P < 0.001）是额外消融的独立预测因素。消融术后58.36±7.12个月时单次手术无房性心律失常的比例为70.48%。对于初次手术的PAF患者，额外消融很常见。较低的LVEF以及术前、术中及PVI后诱发的房颤发作可预测额外消融。
