肺静脉电隔离术后房性心律失常风暴现象的机制及对策

The “atrial arrhythmic storm” phenomenon after segmental pulmonary veins isolation in patients with paroxysmal atrial fibrillation

目的回顾分析阵发心房颤动(房颤)肺静脉电隔离术后早期房颤频繁复发并加重的病例,研讨此现象发生的机制和治疗对策。方法对连续54例药物治疗无效的阵发性房颤患者行肺静脉电隔离术,观察术后两周内的房颤复发情况。结果消融术后两周内10例(18.5%)有房颤早期复发或合并快速房性心律失常发作,其中4例(7.4%)出现肺静脉电隔离术后房性心律失常风暴现象。此4例患者联合使用抗心律失常药物两周左右心律逐渐恢复正常,继续服药至3个月,停药后房性心律失常风暴患者仅有1例仍有房颤发作,行二次肺静脉电隔离消融术,术后无房颤发作。结论消融术后早期房颤发作较常见,少数患者短期内房颤发作更加频繁,表现为房性心律失常风暴现象。其可能为多种因素联合作用所致,联合抗心律失常药物治疗有效,不必急于短时间内二次消融。

Objective The aim of this study was to investigate the mechanisms and the possible treatment of early and frequent recurrence of atrial fibrillation after segmental pulmonary veins isolation （PVI） in patients with paroxysmal atrial fibrillation （AF）. Methods and Results Guided by Lasso mapping catheter, segmental pulmonary veins isolation was performed using radiofrequency energy in 54 consecutive patients （mean age 53 ±15 years） with recurrent documented symptomatic paroxysmal AF. Early recurrence of AF and rapid atrial arrhythmia occurred in 10 out of 54 patients （18.5%） within two weeks after PVI. 4 out of 10 patients （7.4 % ） experienced early and frequent recurrence of atrial fibrillation and atrial tachyarrhythmia, which we termed as “atrial arrhythnfic storm”. The 4 patients were treated with class Ⅰ and Ⅲ antiarrhythmic drugs for 3 months. The “atrial arrhythmic storm” subided apparently and disappeared within two weeks after antiarrhythmic drug therapy. Only 1 patient still suffered from paroxysmal AF after drug control at mean follow-up of 3 months. After repeat ablation, there was no occurrence of AF and atrial arrhythmia in this patient. Conclusion A few paroxysmal atrial fibrillation patients experienced “atrial arrhythmic storm” after segmental pulmonary veins isolation. It is suggested that “atrial arrbythmic storm” after PVI may due to a lot of factors and combined antiarrhythmic drug therapy may be feasible. Early repeat ablation in oatients with “atrial arrhythmic storm” may not be necessary.