題名:Mechanisms of recurrent atrial fibrillation: comparisons
between segmental ostial versus circumferential pulmonary vein isolation.
作者:陳亦仁
Lo LW; Tai CT; Lin YJ; Chang SL; Wongcharoen W; Hsieh MH; Tuan TC; Udyavar AR; Hu YF; Chen YJ; Tsao HM;
Chen SA.
貢獻者:臨床醫學研究所
上傳時間:2009-08-21T08:58:42Z
摘要:BACKGROUND: Electrical isolation of pulmonary veins (PVs) is an effective therapy for atrial fibrillation (AF). Both segmental ostial PV ablation and
circumferential ablation with PV-left atrial (LA) block have been implicated to eliminate AF. However, the
mechanism of the recurrent AF after undergoing either strategy remains unclear. METHODS AND RESULTS: Of the 73 consecutive patients with symptomatic AF that underwent PV isolation and had recurrences of AF, Group 1
consisted of 46 patients (age 56 +/- 13 years old, 35 males) who underwent PV isolation by segmental ostial PV ablation and Group 2 consisted of 27 patients (age 51 +/- 11 years old, 24 males) who underwent
circumferential ablation with PV-LA block. In Group 1, the earliest ectopic beat or ostial PV potentials were targeted. In Group 2, circumferential ablation with PV- LA block was performed by encircling the extraostial regions around the left and right PVs. During the first procedure, all patients had PV-AF. There was no
difference in the non-PV ectopy between Group 1 and Group 2. During the second procedure, the incidence of an LA posterior wall ectopy initiating AF was
significantly lower (20% vs. 0%, P = 0.01) in Group 2.
There was no difference in the PV ectopy initiating AF during the second procedure. CONCLUSION: Circumferential ablation of AF with PV-LA block may eliminate the LA posterior wall ectopy and decrease the incidence of LA
posterior wall ectopy initiating AF during the second procedure.
