Zhao Dongsheng, Dong Yan, Chen Qiushi, Zhang Fengxiang, Zheng Koulong
Department of Cardiology, The Second Affiliated Hospital of Nantong University, Nantong, People's Republic of China.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
Ann Noninvasive Electrocardiol. 2025 Mar;30(2):e70065. doi: 10.1111/anec.70065.
Investigate the distribution of triggers in paroxysmal atrial fibrillation (PAF) patients and assess the efficacy of circumferential pulmonary vein isolationI (CPVI) combined with non-pulmonary veins (PV) trigger ablation over 1 year.
This prospective study included 130 PAF patients undergoing initial catheter ablation. A standardized protocol was applied before CPVI, followed by ablation targeting non-PV triggers. Ablation success was marked by the inability to induce atrial fibrillation (AF) or related arrhythmias. Patients underwent Holter monitoring at intervals post-surgery, culminating in a 7-day exam at 12 months.
Atrial fibrillation (AF) was induced in 88 patients (67.0%), with 94 foci identified. The left pulmonary vein was a common source, but the superior vena cava emerged as the most prevalent non-PV site. The 1-year success rate was 86.0%, with no significant differences in success rates among trigger types. However, non-PV triggers were linked to lower recurrence rates post-surgery (HR 0.27, 95% CI 0.08-0.96, p = 0.04).
The study found that the combination of drug stimulation and high-frequency atrial stimulation before CPVI significantly boosted AF induction rates and revealed a high incidence of non-PV triggers. Effective intraoperative induction and accurate identification of non-PV triggers, particularly in the superior vein cava (SVC), contributed to a substantial reduction in postoperative recurrence rates. This approach suggests a potential strategy for improving outcomes in PAF treatment.
研究阵发性心房颤动（PAF）患者触发因素的分布情况，并评估环肺静脉隔离术（CPVI）联合非肺静脉（PV）触发灶消融术1年的疗效。
这项前瞻性研究纳入了130例接受初次导管消融术的PAF患者。在CPVI之前应用标准化方案，随后针对非PV触发灶进行消融。以不能诱发心房颤动（AF）或相关心律失常为消融成功的标志。患者术后定期进行动态心电图监测，在12个月时进行为期7天的检查。
88例患者（67.0%）诱发了心房颤动（AF），共识别出94个病灶。左肺静脉是常见的起源部位，但上腔静脉是最常见的非PV部位。1年成功率为86.0%，不同触发类型的成功率无显著差异。然而，非PV触发灶与术后较低的复发率相关（HR 0.27，95%CI 0.08 - 0.96，p = 0.04）。
研究发现，CPVI前药物刺激和高频心房刺激相结合可显著提高AF诱发率，并显示非PV触发灶的发生率较高。术中有效诱发并准确识别非PV触发灶，尤其是在上腔静脉（SVC），有助于大幅降低术后复发率。这种方法为改善PAF治疗效果提供了一种潜在策略。
