Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munchen, Germany.
Pacing Clin Electrophysiol. 2023 Feb;46(2):161-168. doi: 10.1111/pace.14656. Epub 2023 Jan 19.
Catheter ablation is an effective treatment for atrial fibrillation (AF,) but arrhythmia recurrence occurs in a relevant number of patients. Mechanisms of late occurring arrhythmias after ablation procedures are not fully understood. We analyzed electrophysiological mechanisms of early and late arrhythmia recurrences in patients who underwent radiofrequency-based catheter ablation of AF.
Consecutive patients who underwent repeat ablation procedures after initial pulmonary vein isolation (PVI) for symptomatic arrhythmia recurrence were analyzed. A total of 110 consecutive patients who underwent catheter ablation for paroxysmal (79%) or persistent AF (21%) were included. Forty-seven patients suffered from early arrhythmia recurrence (group #1: 3-24 months), 29 patients from mid-term arrhythmia recurrences (group #2: 2-5 years), and 34 patients from late arrhythmia recurrences (group #3: > 5 years). Electrical PV reconnection was found in 98% in group #1, 72% in group #2 and 56% in group #3 (p < .001). Mode of arrhythmia recurrence was organized tachycardia in 25%, 28%, and 65% of patients in groups #1, #2, and #3 (p = .001), respectively. Patients with late arrhythmia recurrence had more pronounced left atrial low voltage as compared to patients with early arrhythmia recurrence based on two published scoring system.
Electrical PV reconnection was found in the majority of patients with early AF recurrence after PVI. In patients with late arrhythmia recurrences this mechanism may play an inferior role, with many patients presenting without PV reconnection, but with LA structural alterations. Thus, early and late occurring arrhythmia recurrence after catheter ablation may be the same symptom of different diseases.
导管消融是治疗心房颤动（AF）的有效方法，但相当数量的患者会出现心律失常复发。消融术后晚期心律失常发生的机制尚不完全清楚。我们分析了接受射频导管消融治疗 AF 的患者早期和晚期心律失常复发的电生理机制。
对初始行肺静脉隔离（PVI）后因症状性心律失常复发而再次接受消融的连续患者进行了分析。共纳入 110 例因阵发性（79%）或持续性 AF（21%）接受导管消融的连续患者。47 例患者出现早期心律失常复发（组 1：3-24 个月），29 例患者出现中期心律失常复发（组 2：2-5 年），34 例患者出现晚期心律失常复发（组 3：>5 年）。组 1 中 98%、组 2 中 72%和组 3 中 56%的患者发现电 PV 再连接（p<0.001）。心律失常复发的模式分别为组织性心动过速在组 1、组 2 和组 3 中的患者中占 25%、28%和 65%（p=0.001）。与早期心律失常复发的患者相比，晚期心律失常复发的患者左房低电压更为明显，这是基于两个已发表的评分系统得出的。
在 PVI 后早期 AF 复发的患者中，发现电 PV 再连接在大多数患者中。在晚期心律失常复发的患者中，这种机制可能作用较小，许多患者无 PV 再连接，但有 LA 结构改变。因此，导管消融后早期和晚期心律失常复发可能是同一疾病的不同表现。
