Li Xi, Chen Yanhong, Chen Guanghui, Deng Chengang, Tang Chen, Zhang Jinlin
Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, Hubei, China.
Front Cardiovasc Med. 2023 Jan 9;9:1028053. doi: 10.3389/fcvm.2022.1028053. eCollection 2022.
Single-ring isolation (SRI) of the pulmonary veins and the left atrial post wall (LAPW) is an accepted strategy in atrial fibrillation ablation. Whether SRI combined with superior vena cava isolation (SVCI) could further increase the success rate of paroxysmal atrial fibrillation (PAF) has not been reported.
This study aimed to investigate whether SRI combined with SVCI was feasible and whether it could improve the success rate of PAF ablation.
In our study, sixty patients with PAF from May 2019 to March 2021 were included. SRI plus SVCI was completed with ablation index (AI)-guided high-power ablation. The success rates of SRI and SVCI were 100% and 97%, respectively. One-pass SRI was achieved in 41 out of 60 patients, with 19 out of 60 patients requiring additional ablation to complete the SRI. SVC was not isolated in 2 out of the 60 cases due to concerns about the phrenic nerve (PN) injury. Among the enrolled patients, 2 patients had anomalous pulmonary veins (PVs) (common ostium of inferior PVs). SRI was applied to achieve the PV and PW isolation. After ablation, one patient had an ischemic stroke but recovered without severe morbidity. The average follow-up period was (20 ± 7) months, and single-procedure freedom from atrial arrhythmia was 91.7%. AT/AF recurred in five patients, and 2 out of 5 patients underwent redo ablation. The multi-procedure freedom from atrial arrhythmia was 95%.
Our novel ablation strategy, SRI combined with SVCI, in patients with PAF was feasible and safe, with a relatively high success rate.
肺静脉及左心房后壁的单环隔离（SRI）是心房颤动消融中一种公认的策略。SRI联合上腔静脉隔离（SVCI）是否能进一步提高阵发性心房颤动（PAF）的成功率尚未见报道。
本研究旨在探讨SRI联合SVCI是否可行以及是否能提高PAF消融的成功率。
本研究纳入了2019年5月至2021年3月期间的60例PAF患者。采用消融指数（AI）引导的高功率消融完成SRI加SVCI。SRI和SVCI的成功率分别为100%和97%。60例患者中有41例一次完成SRI，60例中有19例需要额外消融以完成SRI。60例中有2例因担心膈神经（PN）损伤而未隔离上腔静脉。在纳入的患者中，2例有异常肺静脉（下肺静脉共干）。采用SRI实现肺静脉和后壁隔离。消融后，1例患者发生缺血性卒中，但恢复良好，无严重并发症。平均随访期为（20±7）个月，单次手术无房性心律失常的发生率为91.7%。5例患者房性心动过速/心房颤动复发，5例中有2例接受了再次消融。多次手术无房性心律失常的发生率为95%。
我们针对PAF患者的新型消融策略，即SRI联合SVCI，是可行且安全的，成功率相对较高。
