心房颤动肺静脉电隔离术后三磷酸腺苷激发试验的相关因素分析

Factors associating with pulmonary vein reconnection induced by adenosine triphosphate during atrial fibrillation ablation

目的分析心房颤动（房颤）射频消融术中应用三磷酸腺苷（ATP）激发肺静脉（PV）传导恢复的相关凼素。方法连续56例接受PV电隔离术治疗的房颤患者[男38例，年龄（59±12）岁]，在PV隔离20min后给予ATP（0．2mg／kg），观察PV传导恢复与否，并对传导恢复的PV再次消融，直至ATP激发试验阴性，分析与PV传导恢复相关的临床及术中指标。结果19例（33．9％）患者PV传导恢复，其中右侧PV（RPV）4例，左侧PV（LPV）10例，双侧PV传导均恢复5例。室间隔增厚（〉11mm）和LPV消融时间长（≥20min）的患者在ATP试验时更易出现阳性反应（与室间隔≤11mm及IJPV消融时间〈20min者比较，P值分别为0．024和0．021）。结论室间隔增厚和LPV消融时间长是房颤导管射频消融术中PV电位恢复的预测因子。

Objective Adenosine triphosphate （ATP） can provocate acute recovery of conduction of the pulmonary veins （PV） that has been isolated.The objective of this study was to investigate the factors associating with PV reconnection unveiled by ATP. Methods Fifty-six consecutive patients [ 38 male; age （59± 12）years） who underwent pulmonary veins isolation （PVI） for atrial fibrillation were included.Twenty minutes after PVI, all patients received intravenous injection of ATP （0.2 mg/kg）attempting to unmask PV reconnec- tion.If PV reconnection was elicited, additional ablation was performed until dormant conduction was abolished. Results In 19 （33.9%） patients,PV conduction was transiently restored in response to ATP administration. The PV reconnection was observed in 24 ipsilateral PV, including right side PV in 4, left side PV in 10 and both sides in 5.PV reconnection was more common in patients with intraventricular septal thicknesses 〉 11 mm （P = 0. 024 as compared with those ≤ 11 ram） and in those with left PV ablation time longer than 20 min（ P = 0. 031 ,compared with those ablation time〈20 min）. Conclusion Intraventricular septal hypertrophy and prolonged left PV ablation time is the predictors of the PV potential recovery after acute PV isolation.