Yagishita Atsuhiko, Sakama Susumu, Iimura Kazuma, Lee Kyong Hee, Ayabe Kengo, Amino Mari, Ikari Yuji, Yoshioka Koichiro
Department of Cardiology, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
J Interv Card Electrophysiol. 2025 Aug;68(5):977-983. doi: 10.1007/s10840-024-01931-7. Epub 2024 Oct 16.
The mechanistic role of left atrial (LA) structural remodeling as a non-pulmonary vein (PV) trigger in the initiation of atrial fibrillation (AF) remains uncertain. This study is aimed at prospectively evaluating the association between non-PV triggers and LA structural remodeling.
A total of 517 patients undergoing catheter ablation for AF were included. After PV isolation, a standardized protocol was implemented to reveal non-PV triggers, which included burst pacing into AF followed by cardioversion during isoproterenol infusion. If pacing-induced atrial tachycardia (AT) was observed, mapping and catheter ablation were performed.
The mean percentage of LA low-voltage area (LVA) < 0.5 mV incrementally increased during right atrial pacing among the no induction (n = 470), AF (n = 21), and AT (n = 26) groups (2.6 ± 5.7%, 5.5 ± 6.4%, and 18.0 ± 21.5%, respectively; P < 0.001). In the AF induction group, non-PV foci originated from the left atrium in 13 of 25 foci (52%), and 8 of 13 LA non-PV foci (62%) were located in the septal region. All except 1 focus originated from the non-LVA < 0.5 mV (8%), but 8 of the 13 LA foci originated from the LVA < 1.0 mV (62%). There were no differences in AF recurrence among the groups (log-rank, P = 0.160).
The majority of non-PV foci in the LA originated outside regions with advanced structural remodeling, thus suggesting the limited effectiveness of adjunctive ablation guided by the LVA < 0.5 mV during sinus rhythm in eliminating non-PV triggers.
左心房（LA）结构重塑作为心房颤动（AF）起始中非肺静脉（PV）触发因素的机制作用仍不确定。本研究旨在前瞻性评估非PV触发因素与LA结构重塑之间的关联。
共纳入517例行AF导管消融术的患者。在PV隔离后，实施标准化方案以揭示非PV触发因素，包括在异丙肾上腺素输注期间进行猝发起搏诱发AF随后复律。若观察到起搏诱发的房性心动过速（AT），则进行标测和导管消融。
在无诱发（n = 470）、AF（n = 21）和AT（n = 26）组中，右心房起搏期间LA低电压区（LVA）＜0.5 mV的平均百分比逐渐增加（分别为2.6±5.7%、5.5±6.4%和18.0±21.5%；P＜0.001）。在AF诱发组中，25个病灶中有13个（52%）非PV灶起源于左心房，13个LA非PV灶中有8个（62%）位于间隔区域。除1个病灶外，所有病灶均起源于非LVA＜0.5 mV（8%），但13个LA病灶中有8个起源于LVA＜1.0 mV（62%）。各组间AF复发无差异（对数秩检验，P = 0.160）。
LA中的大多数非PV灶起源于结构重塑进展区域之外，因此提示窦性心律期间以LVA＜0.5 mV为指导的辅助消融在消除非PV触发因素方面效果有限。
