|
Journal of Zhejiang University SCIENCE B
ISSN 1673-1581(Print), 1862-1783(Online), Monthly
2014 Vol.15 No.10 P.915-922
Non-pulmonary vein foci induced before and after pulmonary vein isolation in patients undergoing ablation therapy for paroxysmal atrial fibrillation: incidence and clinical outcome
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.
Key words: Atrial fibrillation, Non-pulmonary vein foci, Adenosine triphosphate
创新è¦ç‚¹ï¼šå‘现肺é™è„‰ç”µå¦éš”离å‰è‚ºé™è„‰åœ¨è§¦å‘房颤方é¢èµ·ä¸»è¦ä½œç”¨ï¼ŒçŽ¯è‚ºé™è„‰éš”离术显著é™ä½Žäº†è‚ºé™è„‰çš„æ”¾ç”µæƒ…况,å´åŒæ—¶å¢žå¼ºäº†è‚ºé™è„‰ä»¥å¤–的部ä½è§¦å‘房颤的能力。
ç ”ç©¶æ–¹æ³•ï¼šé€‰æ‹©ä»Ž2010å¹´4月至2011å¹´1月在浙江大å¦é™„å±žé‚µé€¸å¤«åŒ»é™¢é¦–æ¬¡è¡Œæˆ¿é¢¤å°„é¢‘æ¶ˆèžæœ¯çš„è¯ç‰©æ²»ç–—æ— æ•ˆï¼Œå‘作时症状明显的80ä¾‹é˜µå‘æ€§æˆ¿é¢¤æ‚£è€…。所有的患者å‡äºŽè‚ºé™è„‰éš”离å‰åŽé€šè¿‡é™è„‰ç»™äºˆATP(20mg)+ISP(20μg/minï¼‰è¯±å‘æˆ¿é¢¤ã€‚诱å‘å‡ºæˆ¿é¢¤çš„èµ·å§‹éƒ¨åˆ†è¢«æ ‡è®°å’Œè®°å½•ï¼ˆè¯±å‘过程详è§å›¾2)。术åŽå¸¸è§„壿œåŽæ³•林抗å‡ä¸å°‘于3个月,控制INR值2~3;术åŽ3个月åœç”¨æ‰€æœ‰æŠ—心律失常è¯ç‰©ï¼›æœ¯åŽ1个月ã€3个月ã€6个月ã€1å¹´ã€2å¹´æ—¶åŠå½“病人有心悸ç‰ç—‡çŠ¶æ—¶é€šè¿‡24å°æ—¶åЍæ€å¿ƒç”µå›¾å¯¹ç—…人éšè®¿ã€‚
é‡è¦ç»“论:ATP+ISPå¯ä»¥æœ‰æ•ˆè¯±å‘é˜µå‘æ€§æˆ¿é¢¤æ‚£è€…çš„éžè‚ºé™è„‰è§¦å‘ç¶ï¼Œç‰¹åˆ«æ˜¯åœ¨çŽ¯è‚ºé™è„‰éš”离以åŽã€‚术ä¸å¯¹éžè‚ºé™è„‰è§¦å‘ç¶è¿›è¡Œæ¶ˆèžå¯èƒ½ä½¿ç—…äººèŽ·ç›Šï¼Œè™½ç„¶åœ¨æœ¬ç ”ç©¶ä¸éšè®¿ç»“果没有达到统计å¦ä¸Šçš„æ˜¾è‘—差异。
关键è¯ç»„:
References:
Open peer comments: Debate/Discuss/Question/Opinion
<1>
DOI:
10.1631/jzus.B1400146
CLC number:
R541.7+5
Download Full Text:
Downloaded:
3736
Download summary:
<Click Here>Downloaded:
2601Clicked:
10190
Cited:
5
On-line Access:
2024-08-27
Received:
2023-10-17
Revision Accepted:
2024-05-08
Crosschecked:
2014-09-24