Li Xinyu, Yu Houdeng, Lai Shihuang, Liao Yaqi, Yang Yihong, Tian Kejun, Zhong Yiming, Chen Xinguang
Division of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
Cardiol Res Pract. 2024 Oct 15;2024:3672210. doi: 10.1155/2024/3672210. eCollection 2024.
Data comparing the outcomes of loose versus rigorous validation strategies for pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF) are limited. We aimed to prospectively assess the effectiveness of loose versus rigorous validation for PVI in patients with PAF with a maintained sinus rhythm. Patients ( = 117) with PAF were randomized to receive either loose validation ( = 59) or rigorous validation ( = 58) after PVI. The presence of dormant conduction in loose validation was assessed only by adenosine administration followed by isoproterenol infusion. The complete absence of pulmonary vein (PV) potentials in rigorous validation was confirmed by the combination of the Lasso catheter with isoproterenol plus adenosine. Dormant conduction, revealed by validation after PVI, was ablated until all reconnections were eliminated. The procedure time in the rigorous validation group was greater than that in the loose validation group (161.3 ± 52.7 min vs. 142.5 ± 37.6 min, =0.03, respectively). After successful PVI, the detection of dormant PV reconnections in the rigorous validation group was significantly greater than that in the loose validation group (69.0% vs. 37.3%, =0.001). However, after reisolation of the sites of dormant PV conduction, the postablation recurrence rates in 1.3 years were similar between the groups (79.2% vs. 83.6%, =0.67). Rigorous validation can reveal dormant conduction in more than two-thirds of patients with PAF undergoing PVI. However, rigorous validation and additional ablation of the resulting connections do not improve long-term outcomes when a protocol that includes electrophysiological confirmation and pharmacological validation is used.
比较阵发性心房颤动（PAF）患者肺静脉隔离（PVI）中宽松与严格验证策略结果的数据有限。我们旨在前瞻性评估宽松验证与严格验证对维持窦性心律的PAF患者进行PVI的有效性。117例PAF患者在PVI后被随机分为接受宽松验证组（n = 59）或严格验证组（n = 58）。宽松验证中隐匿性传导仅通过静脉注射腺苷随后静脉滴注异丙肾上腺素来评估。严格验证中通过套索导管联合异丙肾上腺素加腺苷来确认肺静脉（PV）电位完全消失。PVI后验证发现的隐匿性传导进行消融直至所有重新连接被消除。严格验证组的手术时间长于宽松验证组（分别为161.3±52.7分钟 vs. 142.5±37.6分钟，P = 0.03）。成功进行PVI后，严格验证组中隐匿性PV重新连接的检出率显著高于宽松验证组（69.0% vs. 37.3%，P = 0.001）。然而，在对隐匿性PV传导部位重新隔离后，两组在1.3年的消融后复发率相似（79.2% vs. 83.6%，P = 0.67）。严格验证可在超过三分之二接受PVI的PAF患者中发现隐匿性传导。然而，当使用包括电生理确认和药理学验证的方案时，严格验证及对由此产生的连接进行额外消融并不能改善长期预后。
