Masuda Masaharu, Asai Mitsutoshi, Iida Osamu, Okamoto Shin, Ishihara Takayuki, Nanto Kiyonori, Kanda Takashi, Tsujimura Takuya, Matsuda Yasuhiro, Okuno Shota, Mano Toshiaki
Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan.
J Atr Fibrillation. 2020 Aug 31;13(2):2165. doi: 10.4022/jafib.2165. eCollection 2020 Aug.
Unmappable regular atrial tachycarrhythmias (ATs) occasionally develop during atrial fibrillation (AF) ablation, and are difficult to treat by conventional ablation. Recently, low-voltage areas (LVAs) have been reported to represent AT substrate. The purpose of this study was to elucidate the efficacy of LVA ablation for unmappable AT.
This observational study included 32 consecutive patients who developed unmappable ATs during and after AF ablation. Unmappable AT was defined as AT lasting for >5 s, but that terminated or changed the activation sequence over too short a time to create a sufficient activation map. We used conventional ablation to target undetermined AT circuits estimated from activation timings of electrograms recorded on the placed electrode catheter, the response to entrainment mappings, and/or diastolic potentials during AT. Subsequently, in cases without successful elimination of unmappable ATs by conventional ablation, LVA (≤ 0.5 mV) ablation was performed at the discretion of the operators.
Conventional ablation failed to eliminate at least one unmappable AT in 29 patients. Among them, LVA ablation was performed in 16 patients. LVA ablation eliminated all the unmappable ATs in 8 of 16 patients. The LVA size did not differ between patients with and without the acute elimination of unmappable ATs (17±11 vs. 21±12 cm2, p = 0.39), and AT/AF recurrence rates were comparable between the two groups (38% vs. 63%, p = 0.62) during a mean follow-up period of 14±8 months.
LVA ablation was efficacious to some extent for the elimination of unmappable ATs refractory to conventional ablation.
在心房颤动（AF）消融过程中偶尔会出现无法标测的规则性房性快速心律失常（ATs），且难以通过传统消融治疗。最近有报道称低电压区（LVAs）代表AT的基质。本研究的目的是阐明LVA消融治疗无法标测的AT的疗效。
本观察性研究纳入了32例在AF消融期间及之后出现无法标测的AT的连续患者。无法标测的AT定义为持续时间>5秒，但在过短时间内终止或改变激动顺序以至于无法创建足够的激动标测图的AT。我们采用传统消融针对根据置于电极导管上记录的心电信号的激动时间、拖带标测反应和/或AT期间的舒张期电位估计的未确定的AT环路。随后，对于传统消融未能成功消除无法标测的AT的病例，由操作者酌情进行LVA（≤0.5 mV）消融。
29例患者的传统消融未能消除至少一种无法标测的AT。其中，16例患者进行了LVA消融。LVA消融使16例患者中的8例所有无法标测的AT均消除。成功急性消除无法标测的AT的患者与未成功消除的患者之间LVA大小无差异（17±11 vs. 21±12 cm²，p = 0.39），且两组在平均14±8个月的随访期内AT/AF复发率相当（38% vs. 63%，p = 0.62）。
LVA消融在一定程度上对消除传统消融难治的无法标测的AT有效。
