肺静脉开口面积与持续性心房颤动射频消融术后复发的关系
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摘要
目的探讨各肺静脉开口面积对持续性心房颤动(简称房颤)患者导管射频消融(RFCA)术后复发的相关性。方法回顾性分析于郑州大学第一附属医院首次且成功行RFCA手术的持续性房颤患者64例,所有患者术前均行左房64排CT血管造影成像检查测定左上肺静脉、左下肺静脉、右上肺静脉、右下肺静脉、左心房容积(LAV)及左心房前后径(LAAPD)。采取CARTO三维标测系统指导下房颤RFCA术。所有患者均于术后1、3、6、9、12个月复查动态心电图,对于术后未见门诊动态心电图复查的给予电话随访,询问房颤是否复发。根据房颤是否复发,将患者分为复发组和未复发组,比较两组患者的一般资料、各肺静脉开口面积、LAV、LAAPD的差异性。结果复发组(26例)与非复发组(38例)相比,复发组RSPV开口面积明显增大[(336.68±132.74)mm~3 vs (256.12±96.46)mm~3;P<0.01],房颤病程较长[(46.50±24.43)个月vs (33.63±11.96)个月;P<0.05]。结论持续性房颤RFCA术后复发与RSPV开口面积及房颤病程长短相关。
Objective To investigate the correlation between the area of pulmonary vein opening area and the recurrence of persistent atrial fibrillation(AF) after radiofrequency catheter ablation(RFCA). Methods Sixty-four patients with persistent AF who underwent radiofrequency catheter ablation successfully for the first time in the first affiliated Hospital of Zhengzhou University were analyzed retrospectively. All patients underwent left atrial CTA examination before operation to determine left superior pulmonary vein, left inferior pulmonary vein,Right superior pulmonary vein(RSPV), right inferior pulmonary vein(RIPV), left atrial volume(LAV) and left atrial anteroposterior diameter(LAAPD). Radiofrequency ablation of AF was guided by CARTO three-dimensional mapping system. All patients were examined with dynamic electrocardiogram(ECG) at 1,3,6,9 and 12 months after RFCA. For those who did not see ambulatory electrocardiogram after operation, they were followed up by telephone and asked if there was any recurrence of AF. According to whether the AF recurred, the patients were divided into recurrent group and no recurrence group,and then we compared the difference of pulmonary vein opening area,the general data,the area of pulmonary vein opening and LAV,LAAPD between the two groups. Results The open area of RSPV was significantly increased in recurrent group(n=26) than that in no recurrence group[(336.68±132.74)mm~3 vs(256.12±96.46)mm~3; P<0.01]. The course of AF was longer in recurrent group(n=38) than that in no recurrence[(46.50±24.43)months vs(33.63±11.96) months; P<0.05]. Conclusion Recurrence after RFCA of persistent AF is related to the RSPV opening area and the duration of AF.[Chinese Journal of Cardiac Pacing and Electrophysiology,2019,33(2):123-127]
Objective To investigate the correlation between the area of pulmonary vein opening area and the recurrence of persistent atrial fibrillation(AF) after radiofrequency catheter ablation(RFCA). Methods Sixty-four patients with persistent AF who underwent radiofrequency catheter ablation successfully for the first time in the first affiliated Hospital of Zhengzhou University were analyzed retrospectively. All patients underwent left atrial CTA examination before operation to determine left superior pulmonary vein, left inferior pulmonary vein,Right superior pulmonary vein(RSPV), right inferior pulmonary vein(RIPV), left atrial volume(LAV) and left atrial anteroposterior diameter(LAAPD). Radiofrequency ablation of AF was guided by CARTO three-dimensional mapping system. All patients were examined with dynamic electrocardiogram(ECG) at 1,3,6,9 and 12 months after RFCA. For those who did not see ambulatory electrocardiogram after operation, they were followed up by telephone and asked if there was any recurrence of AF. According to whether the AF recurred, the patients were divided into recurrent group and no recurrence group,and then we compared the difference of pulmonary vein opening area,the general data,the area of pulmonary vein opening and LAV,LAAPD between the two groups. Results The open area of RSPV was significantly increased in recurrent group(n=26) than that in no recurrence group[(336.68±132.74)mm~3 vs(256.12±96.46)mm~3; P<0.01]. The course of AF was longer in recurrent group(n=38) than that in no recurrence[(46.50±24.43)months vs(33.63±11.96) months; P<0.05]. Conclusion Recurrence after RFCA of persistent AF is related to the RSPV opening area and the duration of AF.[Chinese Journal of Cardiac Pacing and Electrophysiology,2019,33(2):123-127]
引文
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6 Senga M,Fujii E,Sugiura S,et al.Efficacy of linear block at the left atrial roof in atrial fibrillation[J].Journal of Cardiology,2010,55(3):322
7 高建华,王贵生,李剑颖,等.ECG电流调控技术对64MDCT冠状动脉成像质量和放射剂量的影响及评估[J].医学影像学杂志,2007,17(10):1 095
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11 Ha?ssaguerre M,Ja?s P,Shah DC,et al.Catheter ablation of chronic atrial fibrillation targeting the reinitiating triggers[J].Journal of Cardiovascular Electrophysiology,2010,11(1):2
12 Hocini M,Ho SY,Kawara T,et al.Electrical conduction in canine pulmonary veins[J].Circulation,2002,105(20):2 442
13 陈秀雯,高连君,张树龙,等.人的肺静脉前庭心肌的病理组织学特点[J].中华心律失常学杂志,2008,12(1):22
14 Ronghui YMD,Jianzeng DMD,Zhaoqi ZMD,et al.Characteristics in image integration system guiding catheter ablation of atrial fibrillation with a common ostium of inferior pulmonary veins[J].PACE,2010,31(1):93
15 Kocheril AG.Right atrial mapping and linear ablation for paroxysmal atrial fibrillation[J].J Interv Card Electrophysiol,2001,5(4):505
16 董建增.持续性房颤导管消融策略再评价[C].2013中国心电学论坛论文集.2013:499
17 Cabrera JA,Sanchezquintana D,Ho SY,et al.The architecture of the atrial musculature between the orifice of the inferior caval vein and the tricuspid valve:the anatomy of the isthmus[J].Journal of Cardiovascular Electrophysiology,2010,9(11):1 186
18 Wei W,Ge JB,Zou Y,et al.Anatomical characteristics of pulmonary veins for the prediction of postoperative recurrence after radiofrequency catheter ablation of atrial fibrillation[J].Plos One,2014,9(4):e93817
19 Haissaguerre M,Jais P,Shah DC,et al.Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins[J].N Eng J Med,1998,33 (9):659
20 马长生,刘兴鹏,王勇.起源于肺静脉的局灶性心房颤动的电生理特征和射频消融治疗[J].中华心律失常学杂志,2000,4(1):18
2 Arbelo E,Brugada J,Hindricks G,et al.The atrial fibrillation ablation pilot study:a European Survery on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association[J].Eur Heart J,2014,35(22):1 466
3 白中乐,陶海龙,邢军辉,等.NT-proBNP与左房容积变化对早期预测心房颤动射频消融后复发的分析[J].中国循证心血管医学杂志,2017,9(7):804
4 郑桂安,林春艺,翁兰,等.左心耳体积对心房颤动导管射频消融术后复发的预测价值[J].中华心血管病杂志,2017,45(11):924
5 陈志坚,易桂文.2016年ESC心房颤动管理指南更新解读[J].临床心血管病杂志,2016(11):1 076
6 Senga M,Fujii E,Sugiura S,et al.Efficacy of linear block at the left atrial roof in atrial fibrillation[J].Journal of Cardiology,2010,55(3):322
7 高建华,王贵生,李剑颖,等.ECG电流调控技术对64MDCT冠状动脉成像质量和放射剂量的影响及评估[J].医学影像学杂志,2007,17(10):1 095
8 Moe GK,Rheinboldt WC,Abildskov JA.A computer model of atria fibrillation[J].Ain Heart J,1964,38:200
9 Ja?s P,Weerasooriya R,Shah DC,et al.Ablation therapy for atrial fibrillation (AF):past,present and future[J].Cardiovascular Research,2002,54(2):337
10 Knaut M,Tugtekin SM,Spitzer SG,et al.Curative treatment ofchronic atrial fibrillation in patients with simultaneous cardiosurgical disease with intraoperative microwave ablation[C].In ACC 2001 Annual Scientific Session
11 Ha?ssaguerre M,Ja?s P,Shah DC,et al.Catheter ablation of chronic atrial fibrillation targeting the reinitiating triggers[J].Journal of Cardiovascular Electrophysiology,2010,11(1):2
12 Hocini M,Ho SY,Kawara T,et al.Electrical conduction in canine pulmonary veins[J].Circulation,2002,105(20):2 442
13 陈秀雯,高连君,张树龙,等.人的肺静脉前庭心肌的病理组织学特点[J].中华心律失常学杂志,2008,12(1):22
14 Ronghui YMD,Jianzeng DMD,Zhaoqi ZMD,et al.Characteristics in image integration system guiding catheter ablation of atrial fibrillation with a common ostium of inferior pulmonary veins[J].PACE,2010,31(1):93
15 Kocheril AG.Right atrial mapping and linear ablation for paroxysmal atrial fibrillation[J].J Interv Card Electrophysiol,2001,5(4):505
16 董建增.持续性房颤导管消融策略再评价[C].2013中国心电学论坛论文集.2013:499
17 Cabrera JA,Sanchezquintana D,Ho SY,et al.The architecture of the atrial musculature between the orifice of the inferior caval vein and the tricuspid valve:the anatomy of the isthmus[J].Journal of Cardiovascular Electrophysiology,2010,9(11):1 186
18 Wei W,Ge JB,Zou Y,et al.Anatomical characteristics of pulmonary veins for the prediction of postoperative recurrence after radiofrequency catheter ablation of atrial fibrillation[J].Plos One,2014,9(4):e93817
19 Haissaguerre M,Jais P,Shah DC,et al.Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins[J].N Eng J Med,1998,33 (9):659
20 马长生,刘兴鹏,王勇.起源于肺静脉的局灶性心房颤动的电生理特征和射频消融治疗[J].中华心律失常学杂志,2000,4(1):18