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

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.

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

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.