阵发性心房颤动环肺静脉电隔离后能否诱发房性心律失常对复发的预测价值

Inducibility of atrial arrhythmia after circumferential pulmonary vein isolation in patients with paroxysmal atrial fibril-lation:predictive value of recurrence during follow up

目的观察阵发性心房颤动(简称房颤)环肺静脉电隔离后,房性心律失常(AA)能否诱发对房颤复发的预测价值。方法连续41例阵发性房颤患者在心脏三维标测系统及单个肺静脉标测电极导管引导下行左房内环同侧肺静脉消融,达到肺静脉电隔离消融终点后,分别于冠状静脉窦(CS)近端及高位右房予以心房猝发起搏刺激(周长以250ms起始,直至心房不应期)。诱发有意义房颤的定义为诱发出≥30s的任何AA。通过症状、体表心电图或/和24h动态心电图检查随访房颤复发。结果入选的41例患者达到左房-肺静脉电隔离后,16例(39.0%)可诱发出AA,25例(61.0%)未诱发。首次房颤消融患者35例中,13例(37.1%)诱发AA;再次房颤消融患者6例中,3例(50%)诱发。随访平均近6个月时,诱发房颤患者中,7例(43.8%)房颤复发,未诱发的25例患者中8例(32.0%)复发,两组复发率无显著差异(P>0.05)。再次消融组能够诱发房颤3例中,仅1例房颤复发,不能诱发房颤3例中无复发。16例可诱发房颤的患者中,9例诱发房颤持续时间≥1min但<5min者复发4例(44.4%),3例≥5min但<10min者复发1例(33.3%),4例≥10min者复发2例(50%)。结论在阵发性房颤患者中,例数不太多的观察显示,经环肺静脉电隔离后,能否诱发房颤不能预测房颤的复发。

Objective Inducibility of atrial arrhythmia（AA）after circumferential pulmonary vein isolation（CPVI）in patients with paroxysmal atrial fibrillation（AF）was analyzed to assess whether inducibility of AA could be used as a clinical predictor of AF recurrence. Methods Fourty one consecutive patients with symptomatic paroxysmal AF underwent CPVI guided by 3D mapping system and single Lasso technique.After achievement of CPVI,the induction was performed.AA was induced by rapid atrial pacing within the proximal coronary sinus and right atrium.The induction protocol was rapid pacing initiated at cycle length of 250 ms with progressive shortening in a decrement of 10 ms down to refractoriness.AA was considered inducible only if its duration was more than 30 seconds.Symptoms,surface ECG,and 24 hHolter recording were followed up after the procedure. Results Sustained AA were induced after CPVI in 16 of 41patients（39.0%）.Thirteen of the 35patients（37.1%）had inducible AA after the initial procedure and 3of the 6patients（50%）after the second procedure.During an average 6 months of follow-up,7of the 16patients（43.8%）in the AF inducible group had AF recurrence,and 8of the 25patients（32.0%）in the AF non-inducible group had AF recurrence（P〉0.05）.After the second procedure,1of the 3patientsin the AF inducible group had AF recurrence,and no patient of the 3patients in the AF non-inducible group had AF recurrence.4of the 9patients（44.4%）whose inducible AA lasted between 1 min and 5 min had AF recurrence;1of the 3patients（33.3%）whose AA duration more than 5min and less than 10 min hadAF recurrence;2of the 4patients（50%）whose AA duration more than 10 min had AF recurrence. Conclusion Inducibility of AA could not predict the clinical efficacy of CPVI in patients with paroxysmal AF.