Department of Electrophysiology, German Heart Centre Munich, Lazarettstr. 36, 80636, Munich, Germany.
Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Herzschrittmacherther Elektrophysiol. 2022 Mar;33(1):71-76. doi: 10.1007/s00399-021-00836-6. Epub 2022 Jan 10.
Catheter ablation of atrial fibrillation (AF) has become a well-established and widely used therapy, with pulmonary vein isolation (PVI) being the key modality of ablation. However, arrhythmia recurrences after PVI are common, with a relevant number of patients undergoing repeat ablation. Arrhythmia recurrence after PVI may vary regarding time point and mode of recurrence. While early arrhythmia recurrences of AF after PVI are mostly found to be the product of electrical reconnection of the pulmonary veins, the exact mechanisms of very late arrhythmia recurrence, occurring later than 12 months after successful PVI, remain unclear. This review provides an overview on the current evidence on time point and mechanisms of arrhythmia recurrence after PVI focussing on late arrhythmia recurrence.
The incidence of late arrhythmia recurrence after PVI can lie at a rate of up to 30% according to long-term follow-up studies. Mechanisms of recurrence include electrical reconnection of previously isolated pulmonary veins and development of atrial fibrosis. The use of cryoballoon ablation is likely to be more effective in reducing late arrhythmia recurrences compared to radiofrequency ablation. Novel scores such as the MB-LATER score or the APPLE score may become useful tools in predicting arrhythmia recurrence after PVI.
Late arrhythmia recurrence after PVI is common and leads to a relevant impairment of long-term success. Relevant data are currently limited and exact mechanisms of arrhythmia recurrence remain unclear. Further studies are needed to elucidate pathogenetic mechanisms of late arrhythmia recurrence after PVI in order to improve treatment strategies.
房颤（AF）的导管消融已成为一种成熟且广泛应用的治疗方法，肺静脉隔离（PVI）是消融的关键方式。然而，PVI 后心律失常的复发较为常见，许多患者需要重复消融。PVI 后心律失常的复发可能与复发的时间点和模式有关。虽然 PVI 后早期的 AF 心律失常复发大多是由于肺静脉的电重新连接所致，但确切的非常晚期心律失常复发的机制（即 PVI 成功后 12 个月后发生的心律失常复发）仍不清楚。本文就 PVI 后心律失常复发的时间点和机制（重点关注晚期心律失常复发）的最新证据进行综述。
根据长期随访研究，PVI 后晚期心律失常的复发率可高达 30%。复发的机制包括先前隔离的肺静脉的电重新连接和心房纤维化的发展。与射频消融相比，冷冻球囊消融可能更有效地降低晚期心律失常的复发。新型评分，如 MB-LATER 评分或 APPLE 评分，可能成为预测 PVI 后心律失常复发的有用工具。
PVI 后晚期心律失常的复发较为常见，导致长期成功率显著下降。目前相关数据有限，心律失常复发的确切机制仍不清楚。需要进一步的研究来阐明 PVI 后晚期心律失常复发的发病机制，以改善治疗策略。
