Shinohara Masaya, Fujino Tadashi, Wada Ryo, Yao Shintaro, Yano Kensuke, Akitsu Katsuya, Koike Hideki, Kinoshita Toshio, Yuzawa Hitomi, Ikeda Takanori
Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Tokyo Japan.
Department of Cardiovascular Medicine, Toho University Graduate School of Medicine Tokyo Japan.
Circ Rep. 2024 Feb 3;6(3):37-45. doi: 10.1253/circrep.CR-23-0069. eCollection 2024 Mar 8.
Catheter ablation (CA) of atrial fibrillation (AF) triggers, including non-pulmonary vein (PV) foci, contributes to improved procedural outcomes. However, the clinical significance of an AF trigger ablation during second CA procedures for nonparoxysmal AF is unknown. We enrolled 94 patients with nonparoxysmal AF undergoing a second CA. Intracardiac cardioversion during AF using high-dose isoproterenol was performed to determine the presence or absence of AF triggers. PV re-isolations were performed if PV potentials recurred, and if AF triggers appeared from any non-PV sites, additional ablation was added to those sites. We investigated the incidence of atrial arrhythmia recurrence (AAR) >3 months post-CA. Of the 94 enrolled patients, AF triggers were identified in 65 (69.1%), and of those with AF triggers, successful elimination of the triggers was achieved in 47 patients (72.3%). Multivariate analysis revealed that no observed AF triggers were a significant predictor of AAR (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.21-3.46, P=0.019). In a subanalysis of the patients with AF triggers, multivariate analysis showed that unsuccessful trigger ablation was significantly associated with AAR (HR 5.84, 95% CI 2.79-12.22, P<0.01). Having no observed AF triggers during a second CA session significantly increased the risk of AAR, as did unsuccessful CA of AF triggers.
导管消融（CA）房颤（AF）触发灶，包括非肺静脉（PV）灶，有助于改善手术效果。然而，在非阵发性AF的第二次CA手术中，AF触发灶消融的临床意义尚不清楚。我们纳入了94例接受第二次CA的非阵发性AF患者。在AF期间使用高剂量异丙肾上腺素进行心内转复，以确定是否存在AF触发灶。如果PV电位复发，则进行PV再次隔离，如果从任何非PV部位出现AF触发灶，则在这些部位增加额外消融。我们调查了CA后>3个月时房性心律失常复发（AAR）的发生率。在94例纳入患者中，65例（69.1%）发现有AF触发灶，在有AF触发灶的患者中，47例（72.3%）成功消除了触发灶。多因素分析显示，未观察到AF触发灶是AAR的显著预测因素（风险比[HR]1.97，95%置信区间[CI]1.21-3.46，P=0.019）。在对有AF触发灶患者的亚分析中，多因素分析表明触发灶消融失败与AAR显著相关（HR 5.84，95%CI 2.79-12.22，P<0.01）。在第二次CA手术期间未观察到AF触发灶显著增加了AAR风险，AF触发灶CA失败也如此。
