Choi Yun Young, Shim Jaemin, Kim Yun Gi, Min Kyongjin, Roh Seung-Young, Kim Jin Seok, Choi Jong-Il, Kim Young-Hoon
Department of Internal Medicine, Graduate School, Kyung Hee University, Seoul 02447, Korea.
Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea.
J Clin Med. 2022 Sep 26;11(19):5679. doi: 10.3390/jcm11195679.
Adenosine can cause dormant electrical conduction between the pulmonary vein and left atrium after pulmonary vein isolation (PVI). Adenosine can also induce atrial fibrillation (AF) during catheter ablation. However, the clinical outcomes and effects of additional ablation for the trigger sites of adenosine-induced AF (AIAF) are unknown. This study therefore aimed to evaluate the clinical significance of AIAF.
Between January 2010 and September 2019, we analyzed 616 consecutive patients with paroxysmal AF (PAF) who underwent radiofrequency catheter ablation (RFCA), including wide-area circumferential pulmonary vein isolation (PVI) and post-PVI adenosine testing.
Among 616 patients, 134 (21.7%) and 34 (5.5%) showed dormant conduction and AIAF, respectively. Eight patients (1.3%) had both dormant conduction and AIAF. The AF recurrence rate was not significantly different between patients with and without AIAF (16.7% vs. 18.6%, log-rank = 0.827) during a mean follow-up period of 17.9 ± 18 months. Additional RFCA for the trigger site was attempted in 10 patients with AIAF; however, the recurrence rate of atrial arrhythmias was also not different between the groups with and without additional ablation (20% vs. 16.7%, log-rank = 0.704).
AIAF after PVI was not clinically associated with recurrence during long-term follow-up. Ablation of the trigger site in AIAF did not improve the clinical outcomes.
肺静脉隔离（PVI）后，腺苷可导致肺静脉与左心房之间出现隐匿性电传导。腺苷在导管消融过程中也可诱发心房颤动（AF）。然而，腺苷诱发房颤（AIAF）触发灶的额外消融的临床结果和效果尚不清楚。因此，本研究旨在评估AIAF的临床意义。
在2010年1月至2019年9月期间，我们分析了616例连续接受射频导管消融（RFCA）的阵发性房颤（PAF）患者，包括大面积环肺静脉隔离（PVI）和PVI术后腺苷检测。
在616例患者中，分别有134例（21.7%）和34例（5.5%）出现隐匿性传导和AIAF。8例患者（1.3%）同时存在隐匿性传导和AIAF。在平均17.9±18个月的随访期内，有AIAF和无AIAF的患者房颤复发率无显著差异（16.7%对18.6%，对数秩检验=0.827）。对10例AIAF患者尝试对触发灶进行额外的RFCA；然而，有和没有额外消融的组之间房性心律失常的复发率也没有差异（20%对16.7%，对数秩检验=0.704）。
PVI术后的AIAF在长期随访中与复发无临床相关性。对AIAF触发灶进行消融并不能改善临床结果。
