Wei Wei, Fang Xianhong, Shehata Michael, Wang Xunzhang, Zhan Xianzhang, Deng Hai, Liao Hongtao, Liao Zili, Liu Yang, Xue Yumei, Wu Shulin
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Cardiovasc Med. 2021 Nov 16;8:716400. doi: 10.3389/fcvm.2021.716400. eCollection 2021.
To study the benefit of adenosine triphosphate (ATP) in evaluating ablation endpoints of accessory pathways (AP) and subsequent long-term prognosis. We reviewed consecutive patients with supraventricular tachycardias due to APs that underwent radiofrequency catheter ablation (RFCA) from January 2016 to September 2018 in our center. The patients were divided into two groups: the ATP group (who had passed both the ATP test and PES after ablation as the endpoint) and the non-ATP group (who had passed PES only after ablation as the endpoint). We reviewed the patients' intra-cardiac electrograms and analyzed their long-term outcomes. In total, 1,343 patients underwent successful RFCA. There were 215 patients in the ATP group with one lost to follow-up. There were 1,128 patients in the non-ATP group with 39 lost to follow-up. Twenty-three patients in the ATP group demonstrated additional electrophysiological entities due to ATP administration, including reappearance of the ablated APs in 16 patients, discovery of PES-undetected APs in 5, induction of atrial fibrillation in 5, premature atrial contractions in 1, and premature ventricular contractions in another. During the 7 to 39 months (average 24.4 ± 9.5 months) follow-up, the recurrence rate was 8.41% (18/214) in the ATP group and 6.80% (74/1,084) in the non-ATP group. In subjects with recurrence, 14 patients (14/18 = 77.8%) in the ATP group and 50 patients (50/74 = 67.6%) in the non-ATP group accepted redo ablations. Among the ATP-group, all the 14 redo APs were the old ones as before. Among the non-ATP-group, redo ablations confirmed that 39 APs were the old ones, while 20 APs were newly detected ones which had been missed previously. The difference in recurrent AP locations confirmed by redo procedures between the two groups was significant ( = 0.008). In the non-ATP group, 20 (40%) of redo cases were proven to have multiple APs, while 33 (3.3%) cases who did not suffer from recurrence had multiple APs. Existences of multiple APs in recurred cases were significantly higher than that in non-recurred ones in the non-ATP group ( < 0.001), while there was no such difference in the ATP group ( = ). The existence of multiple APs was more common in recurrent cases if ATP was not used for confirmation of ablation endpoints. ATP probably has additional value over PES alone by detecting weak AP conductions. ATP can evoke atrial and ventricular arrhythmias.
研究三磷酸腺苷（ATP）在评估旁路（AP）消融终点及后续长期预后中的作用。我们回顾了2016年1月至2018年9月在本中心因AP导致室上性心动过速而接受射频导管消融（RFCA）的连续患者。患者分为两组：ATP组（消融后通过ATP试验和程序电刺激（PES）作为终点）和非ATP组（消融后仅通过PES作为终点）。我们回顾了患者的心内电图并分析了他们的长期结局。共有1343例患者成功接受了RFCA。ATP组有215例患者，1例失访。非ATP组有1128例患者，39例失访。ATP组有23例患者因ATP给药出现额外的电生理情况，包括16例消融的AP重新出现，5例发现PES未检测到的AP，5例诱发心房颤动，1例房性早搏，另1例室性早搏。在7至39个月（平均24.4±9.5个月）的随访中，ATP组的复发率为8.41%（18/214），非ATP组为6.80%（74/1084）。在复发的患者中，ATP组有14例患者（14/18 = 77.8%），非ATP组有50例患者（50/74 = 67.6%）接受了再次消融。在ATP组中，所有14例再次消融的AP都是之前的旧AP。在非ATP组中，再次消融证实39例AP是旧的，而20例AP是先前漏诊的新发现的AP。两组经再次手术证实的复发AP位置差异有统计学意义（P = 0.008）。在非ATP组中，20例（40%）再次消融的病例被证实有多个AP，而33例（3.3%）未复发的病例有多个AP。非ATP组复发病例中多个AP的存在明显高于未复发病例（P < 0.001），而ATP组无此差异（P = ）。如果不使用ATP来确认消融终点，多个AP的存在在复发病例中更常见。ATP可能比单独使用PES有额外价值，可检测到微弱的AP传导。ATP可诱发心房和心室心律失常。
