JZUS - Journal of Zhejiang University SCIENCE

Journal of Zhejiang University SCIENCE B

Accepted manuscript available online (unedited version)

Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome

Author(s): Hui Cheng¹, Yin-yin Dai², Ru-hong Jiang¹, Qiang Liu¹, Ya-xun Sun¹, Jian-wei Lin¹, Zu-wen Zhang¹, Shi-quan Chen¹, Jun Zhu¹, Xia Sheng¹, Chen-yang Jiang¹
Affiliation(s): 1. Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China;2. Department of Cardiology, the First Peoples Hospital of Xiaoshan, Hangzhou 311200, China
Corresponding email(s): jiangchenyang@hotmail.com
Key Words: Atrial fibrillation, Non-pulmonary vein foci, Adenosine triphosphate

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Hui Cheng, Yin-yin Dai, Ru-hong Jiang, Qiang Liu, Ya-xun Sun, Jian-wei Lin, Zu-wen Zhang, Shi-quan Chen, Jun Zhu, Xia Sheng, Chen-yang Jiang. Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome[J]. Journal of Zhejiang University Science B,in press.Frontiers of Information Technology & Electronic Engineering,in press.https://doi.org/10.1631/jzus.B1400146

@article{title="Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome",
author="Hui Cheng, Yin-yin Dai, Ru-hong Jiang, Qiang Liu, Ya-xun Sun, Jian-wei Lin, Zu-wen Zhang, Shi-quan Chen, Jun Zhu, Xia Sheng, Chen-yang Jiang",
journal="Journal of Zhejiang University Science B",
year="in press",
publisher="Zhejiang University Press & Springer",
doi="https://doi.org/10.1631/jzus.B1400146"
}

%0 Journal Article
%T Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome
%A Hui Cheng
%A Yin-yin Dai
%A Ru-hong Jiang
%A Qiang Liu
%A Ya-xun Sun
%A Jian-wei Lin
%A Zu-wen Zhang
%A Shi-quan Chen
%A Jun Zhu
%A Xia Sheng
%A Chen-yang Jiang
%J Journal of Zhejiang University SCIENCE B
%P 915-922
%@ 1673-1581
%D in press
%I Zhejiang University Press & Springer
doi="https://doi.org/10.1631/jzus.B1400146"

TY - JOUR
T1 - Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome
A1 - Hui Cheng
A1 - Yin-yin Dai
A1 - Ru-hong Jiang
A1 - Qiang Liu
A1 - Ya-xun Sun
A1 - Jian-wei Lin
A1 - Zu-wen Zhang
A1 - Shi-quan Chen
A1 - Jun Zhu
A1 - Xia Sheng
A1 - Chen-yang Jiang
J0 - Journal of Zhejiang University Science B
SP - 915
EP - 922
%@ 1673-1581
Y1 - in press
PB - Zhejiang University Press & Springer
ER -
doi="https://doi.org/10.1631/jzus.B1400146"

Abstract
Chinese Summary
Academic Network
Reviewer Comment

Abstract: Objective: To evaluate the incidence and clinical outcome of adenosine triphosphate (ATP) plus isoproterenol (ISP)-induced non-pulmonary vein (PV) foci before and after circumferential PV isolation (CPVI) during index ablation in patients with paroxysmal atrial fibrillation (PAF). Methods: In 80 consecutive patients undergoing catheter ablation for drug-refractory, symptomatic PAF at our hospital from April 2010 to January 2011, atrial fibrillation (AF) was provoked with ATP (20 mg) and ISP (20 μg/min) administration before and after CPVI. The spontaneous initiation of AF was mapped and recorded. Results: Before ablation, AF mostly originating from PVs (PV vs. non-PV, 36/70 vs. 3/70; P<0.01) was induced in 39 patients with sinus rhythm. CPVI significantly suppressed AF inducibility; however, more non-PV foci were provoked (post-CPVI vs. pre-CPVI, 13/76 vs. 3/70; P=0.016). Patients with pre- and post-CPVI induced AF (n=49) were divided according to non-PV foci being induced (group N, n=17) or not (group P, n=32). After mean (19.2±8.2) months follow-up, 88.2% (15/17) and 65.6% (21/32) of patients in groups N and P, respectively, were free from AF recurrence (P=0.088). Conclusions: ATP+ISP administration effectively provokes non-PV foci, especially after CPVI in PAF patients. Although in this study difference did not achieve statistical significance, supplementary ablation targeting non-PV foci might benefit clinical outcome.

阵发性房颤患者肺静脉隔离前后非肺静脉触发灶的诱发情况及随访研究

研究目的：观察阵发性房颤患者分别在肺静脉隔离前后联合使用三磷酸腺苷（ATP）+异丙（去甲）肾上腺素（ISP）对非肺静脉触发灶的诱发情况以及消融非肺静脉触发灶后的临床疗效。
创新要点：发现肺静脉电学隔离前肺静脉在触发房颤方面起主要作用，环肺静脉隔离术显著降低了肺静脉的放电情况，却同时增强了肺静脉以外的部位触发房颤的能力。
研究方法：选择从2010年4月至2011年1月在浙江大学附属邵逸夫医院首次行房颤射频消融术的药物治疗无效，发作时症状明显的80例阵发性房颤患者。所有的患者均于肺静脉隔离前后通过静脉给予ATP（20mg）+ISP（20μg/min）诱发房颤。诱发出房颤的起始部分被标记和记录（诱发过程详见图2）。术后常规口服华法林抗凝不少于3个月，控制INR值2～3；术后3个月停用所有抗心律失常药物；术后1个月、3个月、6个月、1年、2年时及当病人有心悸等症状时通过24小时动态心电图对病人随访。
重要结论：ATP+ISP可以有效诱发阵发性房颤患者的非肺静脉触发灶，特别是在环肺静脉隔离以后。术中对非肺静脉触发灶进行消融可能使病人获益，虽然在本研究中随访结果没有达到统计学上的显著差异。
阵发性房颤；非肺静脉触发灶；三磷酸腺苷

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References

[1] Allessie,M.A, Boyden,P.A, Camm,A.J, 2001, Pathophysiology and prevention of atrial fibrillation Circulation, 103(5):769-777.

[2] Armour,J.A, Murphy,D.A, Yuan,B.X, 1997, Gross and microscopic anatomy of the human intrinsic cardiac nervous system Anat Rec, 247(2):289-298.

[3] Chang,H.Y, Lo,L.W, Lin,Y.J, 2013, Long-term outcome of catheter ablation in patients with atrial fibrillation originating from nonpulmonary vein ectopy J Cardiovasc Electrophysiol, 24(3):250-258.

[4] Chen,S.A, Tai,C.T, Yu,W.C, 1999, Right atrial focal atrial fibrillation: electrophysiologic characteristics and radiofrequency catheter ablation J Cardiovasc Electrophysiol, 10(3):328-335.

[5] Ganesan,A.N, Shipp,N.J, Brooks,A.G, 2013, Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis J Am Heart Assoc, 2(2):e004549-.

[6] Goette,A, Honeycutt,C, Langberg,J.J, 1996, Electrical remodeling in atrial fibrillation. Time course and mechanisms Circulation, 94(11):2968-2974.

[7] Hassaguerre,M, Jas,P, Shah,D.C, 1998, Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins N Engl J Med, 339(10):659-666.

[8] Jiang,R.H, Po,S.S, Tung,R, 2014, Incidence of pulmonary vein conduction recovery in patients without clinical recurrence after ablation of paroxysmal atrial fibrillation: mechanistic implications Heart Rhythm, 11(6):969-976.

[9] Lerman,B.B, Belardinelli,L, 1991, Cardiac electrophysiology of adenosine. Basic and clinical concepts Circulation, 83(5):1499-1509.

[10] Lin,W.S, Tai,C.T, Hsieh,M.H, 2003, Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy Circulation, 107(25):3176-3183.

[11] Morillo,C.A, Klein,G.J, Jones,D.L, 1995, Chronic rapid atrial pacing. Structural, functional, and electrophysiological characteristics of a new model of sustained atrial fibrillation Circulation, 91(5):1588-1595.

[12] Morita,H, Zipes,D.P, Morita,S.T, 2012, The role of coronary sinus musculature in the induction of atrial fibrillation Heart Rhythm, 9(4):581-589.

[13] Nakagawa,H, Scherlag,B.J, Patterson,E, 2009, Pathophysiologic basis of autonomic ganglionated plexus ablation in patients with atrial fibrillation Heart Rhythm, 6(12 Suppl.):S26-S34.

[14] Patterson,E, Po,S.S, Scherlag,B.J, 2005, Triggered firing in pulmonary veins initiated by autonomic nerve stimulation Heart Rhythm, 2(6):624-631.

[15] Po,S.S, Scherlag,B.J, Yamanashi,W.S, 2006, Experimental model for paroxysmal atrial fibrillation arising at the pulmonary vein-atrial junctions Heart Rhythm, 3(2):201-208.

[16] Shah,D, Hassaguerre,M, Jas,P, 2003, Nonpulmonary vein foci: do they exist? Pacing Clin Electrophysiol, 26(7 Pt 2):1631-1635.

[17] Sotomi,Y, Inoue,K, Ito,N, 2013, Cause of very late recurrence of atrial fibrillation or flutter after catheter ablation for atrial fibrillation Am J Cardiol, 111(4):552-556.

[18] Wijffels,M.C, Kirchhof,C.J, Dorland,R, 1995, Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats Circulation, 92(7):1954-1968.

[19] Workman,A.J, Kane,K.A, Rankin,A.C, 1999, Ionic basis of a differential effect of adenosine on refractoriness in rabbit AV nodal and atrial isolated myocytes Cardiovasc Res, 43(4):974-984.

[20] Yamaguchi,T, Tsuchiya,T, Miyamoto,K, 2010, Characterization of non-pulmonary vein foci with an EnSite array in patients with paroxysmal atrial fibrillation Europace, 12(12):1698-1706.

[21] Zimmermann,M, Kalusche,D, 2001, Fluctuation in autonomic tone is a major determinant of sustained atrial arrhythmias in patients with focal ectopy originating from the pulmonary veins J Cardiovasc Electrophysiol, 12(3):285-291.

[22] Zipes,D.P, Knope,R.F, 1972, Electrical properties of the thoracic veins Am J Cardiol, 29(3):372-376.

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阵发性房颤患者肺静脉隔离前后非肺静脉触发灶的诱发情况及随访研究

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References