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Journal of Zhejiang University SCIENCE B

ISSN 1673-1581(Print), 1862-1783(Online), Monthly

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

Chinese Summary  <280> é˜µå‘性房颤患者肺é™è„‰éš”离å‰åŽéžè‚ºé™è„‰è§¦å‘ç¶çš„è¯±å‘æƒ…况åŠéšè®¿ç ”ç©¶

ç ”ç©¶ç›®çš„ï¼šè§‚å¯Ÿé˜µå‘æ€§æˆ¿é¢¤æ‚£è€…分别在肺é™è„‰éš”离å‰åŽè”åˆä½¿ç”¨ä¸‰ç£·é…¸è…ºè‹·ï¼ˆATP)+异丙(去甲)肾上腺素(ISP)对éžè‚ºé™è„‰è§¦å‘ç¶çš„è¯±å‘æƒ…å†µä»¥åŠæ¶ˆèžéžè‚ºé™è„‰è§¦å‘ç¶åŽçš„临床疗效。
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。
研究方法:选择从2010å¹´4月至2011å¹´1æœˆåœ¨æµ™æ±Ÿå¤§å­¦é™„å±žé‚µé€¸å¤«åŒ»é™¢é¦–æ¬¡è¡Œæˆ¿é¢¤å°„é¢‘æ¶ˆèžæœ¯çš„è¯ç‰©æ²»ç–—无效,å‘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‘出房颤的起始部分被标记和记录(诱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“病人有心悸等症状时通过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€‚术中对éžè‚ºé™è„‰è§¦å‘ç¶è¿›è¡Œæ¶ˆèžå¯èƒ½ä½¿ç—…人获益,虽然在本研究中éšè®¿ç»“果没有达到统计学上的显著差异。

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DOI:

10.1631/jzus.B1400146

CLC number:

R541.7+5

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On-line Access:

2024-08-27

Received:

2023-10-17

Revision Accepted:

2024-05-08

Crosschecked:

2014-09-24

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