Efficacy of Additional Radiofrequency Applications for Spontaneous Dissociated Pulmonary Vein Activity After Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation

被引：11

作者：

Doi, Atsushi ^{[1
]}

Satomi, Kazuhiro ^{[1
]}

Makimoto, Hisaki ^{[1
]}

Yokoyama, Teruki ^{[1
]}

Yamada, Yuko ^{[1
]}

Okamura, Hideo ^{[1
]}

Noda, Takashi ^{[1
]}

Aiba, Takeshi ^{[1
]}

Aihara, Naohiko ^{[1
]}

Yasuda, Satoshi ^{[1
]}

Ogawa, Hisao ^{[1
]}

Kamakura, Shiro ^{[1
]}

Shimizu, Wataru ^{[1
]}

机构：

[1] Natl Cerebral & Cardiovasc Ctr, Div Arrhythmia & Elect, Suita, Osaka 5658565, Japan

来源：

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY | 2013年 / 24卷 / 08期

关键词：

atrial fibrillation; catheter ablation; dissociated pulmonary vein activity; pulmonary vein isolation; PVI automaticity; DOUBLE-LASSO TECHNIQUE; CATHETER ABLATION; ANTRUM ISOLATION; CONDUCTION; INITIATION;

D O I：

10.1111/jce.12153

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Radiofrequency Applications for Spontaneous Dissociated Pulmonary Vein Activity BackgroundThe aim is to evaluate the efficacy of additional radiofrequency ablation (RFCA) for spontaneous dissociated pulmonary vein activity (DPV-spike) after PV isolation (PVI) in patients with paroxysmal atrial fibrillation (AF). MethodsOne hundred fifty-two consecutive patients with paroxysmal AF referred for RFCA were enrolled. When DPV-spike was documented after PVI, we randomly assigned these patients to receive additional RFCA for DPV-spike or only PVI. We divided them into 4 groups: 87 patients without DPV-spike after PVI (No-spike group), 31 without DPV-spike after additional RFCA (Successful group), 8 with remaining DPV-spike after additional RFCA (Unsuccessful group), and 26 with DPV-spike after only PVI (Spike group). AF recurrence was evaluated among the 4 groups. ResultsAfter PVI, DPV-spike was documented in 87 PVs (14%) from 65 patients. During 16 9 months of follow-up, the incidence of the freedom from AF was significantly higher in the No-spike group than that in the Spike group and Unsuccessful group (P < 0.05), and tended to be higher in the Successful group than that in the Spike group and Unsuccessful group (P = 0.08 and 0.11, respectively). In a multivariate analysis, the remaining PV-spike after ablation was an independent predictor of AF recurrence (HR 2.44; CI 1.10-5.43, P < 0.05). No major complications including PV stenosis were observed during the follow-up. ConclusionsDPV-spike after PVI may be associated with higher electrical activity within the PVs and may be one of the risk factors for AF recurrence. Additional RFCA for DPV-spike was effective to reduce the AF recurrence after PVI.

引用

页码：894 / 901

页数：8

共 19 条

[1] Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation [J].

Cappato, R ;

Negroni, S ;

Pecora, D ;

Bentivegna, S ;

Lupo, PP ;

Carolei, A ;

Esposito, C ;

Furlanello, F ;

De Ambroggi, L .

CIRCULATION, 2003, 108 (13) :1599-1604

[2] Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins - Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation [J].

Chen, SA ;

Hsieh, MH ;

Tai, CT ;

Tsai, CF ;

Prakash, VS ;

Yu, WC ;

Hsu, TL ;

Ding, YA ;

Chang, MS .

CIRCULATION, 1999, 100 (18) :1879-1886

[3] Mechanisms underlying sustained firing from pulmonary veins: Evidence from pacing maneuvers and pharmacological manipulation [J].

Dixit, S ;

Gerstenfeld, EP ;

Callans, DJ ;

Marchlinsk, FE .

PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2004, 27 (08) :1120-1129

[4]

Geoffrey L, 2011, HEART, V97, P579

[5] Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins [J].

Haïssaguerre, M ;

Jaïs, P ;

Shah, DC ;

Takahashi, A ;

Hocini, M ;

Quiniou, G ;

Garrigue, S ;

Le Mouroux, A ;

Le Métayer, P ;

Clémenty, J .

NEW ENGLAND JOURNAL OF MEDICINE, 1998, 339 (10) :659-666

[6] Electrophysiological breakthroughs from the left atrium to the pulmonary veins [J].

Haïssaguerre, M ;

Shah, DC ;

Jaïs, P ;

Hocini, M ;

Yamane, T ;

Deisenhofer, I ;

Chauvin, M ;

Garrigue, S ;

Clémenty, J .

CIRCULATION, 2000, 102 (20) :2463-2465

[7]

Haldar S, 2012, INT J CARDIOL

[8]

Hongwu C, 2011, CIRC J, V75, P73

[9] Incidence and Electrophysiologic Properties of Dissociated Pulmonary Vein Activity Following Pulmonary Vein Isolation During Catheter Ablation of Atrial Fibrillation [J].

Kabra, Rajesh ;

Heist, E. Kevin ;

Barrett, Conor D. ;

Donaldson, David ;

Blendea, Dan ;

Beinart, Roy ;

Koruth, Jacob ;

Singh, Sheldon ;

Ruskin, Jeremy ;

Mansour, Moussa .

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2010, 21 (12) :1338-1343

[10] Prevalence, Electrophysiological Properties, and Clinical Implications of Dissociated Pulmonary Vein Activity Following Pulmonary Vein Antrum Isolation [J].

Miyazaki, Shinsuke ;

Kuwahara, Taishi ;

Kobori, Atsushi ;

Takahashi, Yoshihide ;

Takei, Asumi ;

Sato, Akira ;

Isobe, Mitsuaki ;

Takahashi, Atsushi .

AMERICAN JOURNAL OF CARDIOLOGY, 2011, 108 (08) :1147-1154

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