Durable pulmonary vein isolation but not complex substrate ablation determines the type of arrhythmia recurrence after persistent atrial fibrillation ablation,Journal of Interventional Cardiac Electrophysiology

当前位置： X-MOL 学术 › J. Interv. Card. Electrophysiol. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Durable pulmonary vein isolation but not complex substrate ablation determines the type of arrhythmia recurrence after persistent atrial fibrillation ablation
Journal of Interventional Cardiac Electrophysiology ( IF 2.1 ) Pub Date : 2021-08-10 , DOI: 10.1007/s10840-021-01048-1
Raphael Spittler ₁ , Fabian Bahlke ₁ , Boris Alexander Hoffmann ₁ , Alexandra Marx ₁ , Hanke Mollnau ₁ , Blanca Quesada-Ocete ₁ , Torsten Konrad ₁ , Thomas Rostock ₁

Affiliation

Background

Complex ablation for persistent atrial fibrillation (AF) aims to modify the arrhythmogenic substrates to become incapable to perpetuate the arrhythmia. Ablation-associated determinants of atrial tachycardia (AT) rather than AF recurrences are unknown. The aim of the study was to evaluate the association between the type of arrhythmia recurrence and electrophysiological findings during redo procedures.

Methods

A total number of 384 consecutive patients with persistent AF underwent complex ablation consisting of PV isolation (PVI), biatrial electrogram-guided ablation, and linear ablation with the desired procedural endpoint of AF termination. Electrophysiological findings during redo procedures and its relation to AR type are the subject of this study.

Results

Overall, 177 (46%) patients underwent a second procedure. Patients with AT recurrences had significantly more often persistent PVI (47 vs. 25%; P = 0.002). Moreover, a higher number of recovered PVs were associated with AF recurrence (3 PVs recovered, AF = 16.1% vs. AT = 5.2%; P = 0.02; 4 PVs recovered, AF = 18.5% vs. AT = 6.3%; P = 0.01), regardless of the extent of substrate ablation during the first procedure.

Conclusions

Durable PV isolation but not the extent of atrial substrate ablation determines the type of arrhythmia recurrence. Thus, the PVs may represent dominant perpetuators (and not only triggers) of persistent AF even in the presence of a significantly modified atrial substrate.

中文翻译：

持久的肺静脉隔离而非复杂的基质消融决定了持续性房颤消融后心律失常复发的类型

背景

持续性心房颤动 (AF) 的复杂消融旨在改变致心律失常底物，使其无法使心律失常持续存在。房性心动过速 (AT) 而非 AF 复发的消融相关决定因素尚不清楚。该研究的目的是评估心律失常复发类型与重做过程中的电生理结果之间的关联。

方法

共有 384 名持续性 AF 患者连续接受了复杂消融，包括 PV 隔离 (PVI)、双心房电图引导消融和线性消融，并达到了 AF 终止的理想程序终点。重做过程中的电生理发现及其与 AR 类型的关系是本研究的主题。

结果

总体而言，177 名 (46%) 患者接受了第二次手术。AT 复发患者的持续性 PVI 明显更高（47% 对 25%；P = 0.002）。此外，更多的 PV 恢复与 AF 复发相关（3 PV 恢复，AF = 16.1% vs. AT = 5.2%；P = 0.02；4 PV 恢复，AF = 18.5% vs. AT = 6.3%；P = 0.01），无论第一次手术过程中基板消融的程度如何。