Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
Département de Cardiologie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
Arch Cardiovasc Dis. 2021 Nov;114(11):707-714. doi: 10.1016/j.acvd.2021.06.012. Epub 2021 Oct 5.
The strategy for atrial fibrillation ablation in persistent atrial fibrillation remains controversial. A single-catheter approach was recently validated for pulmonary vein isolation.
To evaluate the feasibility of this approach to performing persistent atrial fibrillation ablation, including pulmonary vein isolation and atrial lines, if needed.
We prospectively included 159 consecutive patients referred to our centre for a first persistent atrial fibrillation ablation between January 2018 and December 2018. All patients underwent pulmonary vein isolation. If the patient was still in atrial fibrillation (spontaneously or inducible), we subsequently performed a stepwise approach, including roof line, anterior mitral line, posterior box lesion and cavotricuspid isthmus line. Finally, if patient remained in atrial fibrillation at the end of the procedure, a synchronized direct-current cardioversion was applied to restore sinus rhythm.
At baseline, 54 patients were in sinus rhythm and underwent pulmonary vein isolation. For patients in atrial fibrillation, after pulmonary vein isolation and ablation of additional lines, if needed, 18 patients were converted to atrial tachycardia and one directly to sinus rhythm; 96 were still in atrial fibrillation and underwent direct-current cardioversion. After a mean follow-up of 17±6 months, 57 patients (36%) experienced atrial arrhythmia recurrence. No deaths, tamponades or phrenic nerve injuries were observed following the procedure. The main mode of arrhythmia recurrence was atrial fibrillation in 75% of cases and atrial tachycardia in 25% of cases.
A single-catheter approach, including pulmonary vein isolation and atrial lines, is feasible and safe in patients undergoing persistent atrial fibrillation ablation, with an acceptable success rate of 64% at mid-term follow-up.
持续性心房颤动的房颤消融策略仍存在争议。最近已经验证了一种用于肺静脉隔离的单导管方法。
评估这种方法对持续性心房颤动消融的可行性，包括肺静脉隔离和心房线，如果需要的话。
我们前瞻性地纳入了 2018 年 1 月至 2018 年 12 月期间因首次持续性心房颤动消融而转诊至我们中心的 159 例连续患者。所有患者均接受了肺静脉隔离。如果患者仍处于心房颤动（自发或可诱导），我们随后进行了逐步方法，包括房顶线、前二尖瓣线、后盒病变和三尖瓣峡部线。最后，如果患者在手术结束时仍处于心房颤动，应用同步直流电转复以恢复窦性心律。
在基线时，54 例患者处于窦性心律并接受了肺静脉隔离。对于处于心房颤动的患者，在进行肺静脉隔离和必要时消融其他线后，18 例患者转为房性心动过速，1 例直接转为窦性心律；96 例仍处于心房颤动并接受直流电转复。平均随访 17±6 个月后，57 例（36%）患者出现房性心律失常复发。术后无死亡、心脏压塞或膈神经损伤。心律失常复发的主要模式是 75%的病例为心房颤动，25%的病例为房性心动过速。
在接受持续性心房颤动消融的患者中，包括肺静脉隔离和心房线在内的单导管方法是可行且安全的，中期随访成功率为 64%。
