Northwell Health, North Shore University Hospital, Department of Cardiology, Division of Electrophysiology, Manhasset, New York, USA.
Brigham and Women's Hospital, Boston, Massachusetts, USA.
Pacing Clin Electrophysiol. 2022 Nov;45(11):1338-1342. doi: 10.1111/pace.14602. Epub 2022 Oct 13.
Master athletes encompass a wide range of exercise enthusiasts. At the extreme, there is an increased risk of atrial fibrillation (AF). Therapies aimed at rate or rhythm control are often limited given unfavorable side effects. Although studies suggest an increase in left atrial (LA) fibrosis in this population, minimal electrophysiologic data exist regarding the LA voltage mapping and the efficacy of AF ablation with pulmonary vein isolation (PVI).
In a retrospective single-center study, we reviewed AF ablations (pulmonary vein isolation and assessment/ablation of non-pulmonary vein triggers) performed in extreme master athletes with AF. We define "extreme" as those who have repeatedly competed in long distance endurance events for a > 10-year period. Bipolar voltage mappings obtained through PENTARAY Catheter (Biosense Webster) were reviewed using CARTO. LA scarring was defined as an area of less than 0.1 mV. All patients were monitored as outpatients for AF recurrence.
Between January 2018 and February 2022, 16 patients (11 marathon runners, four long distance cyclers, and one marathon swimmer) underwent AF ablations. All patients in the cohort were male with an average CHA2DS2-VASc score of 1.2 ± 0.8 and left atrial volume of 34.4 cc/m ± 9.9. A total of eight patients (50%) had persistent AF. One patient (6.3%) had LA scar on bipolar voltage mapping, whom also had a non-pulmonary vein trigger of AF. Bidirectional blocks of the four pulmonary veins were achieved by radiofrequency (RF) ablation in all patients. Freedom from documented recurrence of AF up to 24 months was 93.8%. One patient (6.3%) had recurrence of AF at 14 months and underwent successful cardioversion.
In our series of extreme master athletes with AF, the incidence of LA scarring on bipolar voltage mapping was low and the recurrence of AF following PVI by RF ablation was minimal.
大师级运动员涵盖了广泛的运动爱好者。在极端情况下，心房颤动（AF）的风险增加。鉴于不利的副作用，旨在控制心率或节律的治疗方法通常受到限制。尽管研究表明该人群左心房（LA）纤维化增加，但关于 LA 电压图和肺静脉隔离（PVI）伴 AF 消融的有效性的 LA 电生理数据很少。
在一项回顾性单中心研究中，我们回顾了 AF 消融（肺静脉隔离和评估/消融非肺静脉触发）在 AF 的极端大师级运动员中进行的情况。我们将“极端”定义为那些在 10 年以上的时间里反复参加长距离耐力比赛的运动员。使用 CARTO 回顾通过 PENTARAY 导管（Biosense Webster）获得的双极电压图。LA 瘢痕定义为小于 0.1 mV 的区域。所有患者均作为门诊患者进行 AF 复发监测。
2018 年 1 月至 2022 年 2 月期间，16 名患者（11 名马拉松运动员、4 名长途自行车运动员和 1 名马拉松游泳运动员）接受了 AF 消融。该队列中的所有患者均为男性，平均 CHA2DS2-VASc 评分为 1.2 ± 0.8，左心房容积为 34.4 cc/m ± 9.9。共有 8 名患者（50%）持续性 AF。一名患者（6.3%）在双极电压图上有 LA 瘢痕，其也有 AF 的非肺静脉触发。所有患者均通过射频（RF）消融实现了四支肺静脉的双向阻滞。在 24 个月内，无 AF 记录复发的比例为 93.8%。一名患者（6.3%）在 14 个月时出现 AF 复发，行电复律成功。
在我们的 AF 极端大师级运动员系列中，双极电压图上 LA 瘢痕的发生率较低，RF 消融的 PVI 后 AF 的复发率较低。
