Liu Hao-Tien, Yang Chia-Hung, Lee Hui-Ling, Chang Po-Cheng, Wo Hung-Ta, Wen Ming-Shien, Wang Chun-Chieh, Yeh San-Jou, Chou Chung-Chuan
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan.
PLoS One. 2021 Dec 2;16(12):e0260834. doi: 10.1371/journal.pone.0260834. eCollection 2021.
The therapeutic effect of low-voltage area (LVA)-guided left atrial (LA) linear ablation for non-paroxysmal atrial fibrillation (non-PAF) is uncertain. We aimed to investigate the efficacy of LA linear ablation based on the preexisting LVA and its effects on LA reverse remodeling in non-PAF patients.
We retrospectively evaluated 145 consecutive patients who underwent radiofrequency catheter ablation for drug-refractory non-PAF. CARTO-guided bipolar voltage mapping was performed in atrial fibrillation (AF). LVA was defined as sites with voltage ≤ 0.5 mV. If circumferential pulmonary vein isolation couldn't convert AF into sinus rhythm, additional LA linear ablation was performed preferentially at sites within LVA.
After a mean follow-up duration of 48 ± 33 months, 29 of 145 patients had drugs-refractory AF/LA tachycardia recurrence. Low LA emptying fraction, large LA size and high extent of LVA were associated with AF recurrence. There were 136 patients undergoing LA linear ablation. The rate of linear block at the mitral isthmus was significantly higher via LVA-guided than non-LVA-guided linear ablation. Patients undergoing LVA-guided linear ablation had larger LA size and higher extent of LVA, but the long-term AF/LA tachycardia-free survival rate was higher than the non-LVA-guided group. The LA reverse remodeling effects by resuming sinus rhythm were noted even in patients with a diseased left atrium undergoing extensive LA linear ablation.
LVA-guided linear ablation through targeting the arrhythmogenic LVA and reducing LA mass provides a better clinical outcome than non-LVA guided linear ablation, and outweighs the harmful effects of iatrogenic scaring in non-PAF patients.
低电压区（LVA）引导下的左心房（LA）线性消融治疗非阵发性心房颤动（非PAF）的疗效尚不确定。我们旨在研究基于预先存在的LVA进行LA线性消融的疗效及其对非PAF患者LA逆向重构的影响。
我们回顾性评估了145例连续接受射频导管消融治疗药物难治性非PAF的患者。在心房颤动（AF）时进行CARTO引导的双极电压标测。LVA定义为电压≤0.5 mV的部位。如果环肺静脉隔离不能将AF转为窦性心律，则优先在LVA内的部位进行额外的LA线性消融。
平均随访48±33个月后，145例患者中有29例出现药物难治性AF/LA心动过速复发。LA排空分数低、LA大以及LVA范围大与AF复发相关。有136例患者接受了LA线性消融。通过LVA引导的二尖瓣峡部线性阻滞率明显高于非LVA引导的线性消融。接受LVA引导线性消融的患者LA更大且LVA范围更大，但长期无AF/LA心动过速生存率高于非LVA引导组。即使在患有病变左心房并接受广泛LA线性消融的患者中，也观察到恢复窦性心律带来的LA逆向重构效应。
通过靶向致心律失常的LVA并减少LA质量的LVA引导线性消融比非LVA引导线性消融提供了更好的临床结果，并且在非PAF患者中超过了医源性瘢痕形成的有害影响。
