心房颤动消融术后心房-肺静脉电位传导恢复的随访结果与影响因素

Distribution and predictors of recovery of electrical connections between the pulmonary veins and the left atrium after circumferential pulmonary vein isolation

目的 环肺静脉电隔离术已成为治疗心房颤动（房颤）的一种有效手段,但是心房-肺静脉电位传导恢复是环肺静脉电隔离术需要克服的一个难关.本研究的目的 是明确环肺静脉电隔离术的效果以及影响心房-肺静脉电位传导恢复的因素,以提高消融术成功率,预防复发.方法 232例两次行房颤射频消融的阵发性房颤和持续性房颤患者,采用Lasso环状电极导管标测,明确其心房-肺静脉电位恢复部位,并在CartoTM系统指导下予以消融.并分析患者年龄、性别、房颤病史、体重指数、左心房内径、左心房舒张末内径、左心室射血分数（LVEF）及各合并症与心房-肺静脉电位传导恢复的关系.结果 232例第2次消融术病例术中标测示44例次（19.0%）无心房-肺静脉电位传导恢复,且术中心房-肺静脉电位传导恢复部位（Gap）多存在于左肺静脉前上部65例次（28%）、前下部49例次（21.1%）、右肺静脉后上部59例次（25.4%）及后下部61例次（26.3%）.年龄是房颤消融术后心房-肺静脉电位传导恢复的独立危险因素（P=0.012）,且性别、房颤病史、体重指数、左心房内径、左心房舒张末期内径、LVEF恢复组与未恢复组差异无统计学意义.结论 环肺静脉隔离术后,经长时间随访有约80%的患者心房-肺静脉电位传导恢复,并且心房-肺静脉电位传导存在易恢复区,多集中于左肺静脉前上部、前下部、右肺静脉后上部及后下部.年龄是房颤消融术后心房-肺静脉电位传导恢复的独立危险因素.

Objective Circumferential pulmonary vein isolation（CPVI） is an effective treatment for atrial fibrillation （ AF）, however,the achievement of pulmonary vein isolation is challenging. The aim of our study is to investigate the prevalence of pulmonary vein（PV） conduction recovery during the follow-up after CPVI and explore the distribution and predictors of PV re-connections. Methods Two hundred and thirty-two cases with paroxysmal or persistent AF were enrolled for re-ablation. CartoTM-guided CPVI was performed in all cases with one circular catheter for verification of PVs isolation. The relationship between PV re-connections and variables including age, sex, body mass index, AF history,left atrial diameter, left ventricular end-diastolic dimension,left atrial ejection force were analyzed. Results Two hundred and thirty-two cases underwent 2 procedures, from which no PV re-connections was identified in 44 （ 19. 0% ） cases, meanwhile, PV re-connections were most commonly situated at the left pulmonary antero-superior segment 65 （ 28% ）, left pulmonary the antero-inferior segment 49 （ 21.1% ）, right pulmonary the postero-superior segment 59 （ 25.4% ）, right pulmonary the postero-inferior segment 61 （26.3%）. Age was the only independent risk factor for PV re-connections （ P = 0. 012 ）. While sex, body mass index, AF history, left atrial diameter, left ventricular end-diastolic dimension and left atrial ejection force in PV re-connection group was not different from non re-connection group.Conclusion Recovery of electrical connections between the pulmonary veins and the left atrium was observed in about 80% cases during the follow-up after CPVI. PV re-connections were most commonly situated at the left pulmonary antero-superior segment,left pulmonary the antero-inferior segment, right pulmonary the postero-superior segment, right pulmonary the postero-inferior segment. Age is the only independent risk factor for PV reconnections.