{"title":"心房颤动中左心房结构重塑和非肺静脉病灶的临床意义。","authors":"Atsuhiko Yagishita, Susumu Sakama, Kazuma Iimura, Kyong Hee Lee, Kengo Ayabe, Mari Amino, Yuji Ikari, Koichiro Yoshioka","doi":"10.1007/s10840-024-01931-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The mechanistic role of left atrial (LA) structural remodeling as a non-pulmonary vein (PV) trigger in the initiation of atrial fibrillation (AF) remains uncertain. This study is aimed at prospectively evaluating the association between non-PV triggers and LA structural remodeling.</p><p><strong>Methods: </strong>A total of 517 patients undergoing catheter ablation for AF were included. After PV isolation, a standardized protocol was implemented to reveal non-PV triggers, which included burst pacing into AF followed by cardioversion during isoproterenol infusion. If pacing-induced atrial tachycardia (AT) was observed, mapping and catheter ablation were performed.</p><p><strong>Results: </strong>The mean percentage of LA low-voltage area (LVA) < 0.5 mV incrementally increased during right atrial pacing among the no induction (n = 470), AF (n = 21), and AT (n = 26) groups (2.6 ± 5.7%, 5.5 ± 6.4%, and 18.0 ± 21.5%, respectively; P < 0.001). In the AF induction group, non-PV foci originated from the left atrium in 13 of 25 foci (52%), and 8 of 13 LA non-PV foci (62%) were located in the septal region. All except 1 focus originated from the non-LVA < 0.5 mV (8%), but 8 of the 13 LA foci originated from the LVA < 1.0 mV (62%). There were no differences in AF recurrence among the groups (log-rank, P = 0.160).</p><p><strong>Conclusion: </strong>The majority of non-PV foci in the LA originated outside regions with advanced structural remodeling, thus suggesting the limited effectiveness of adjunctive ablation guided by the LVA < 0.5 mV during sinus rhythm in eliminating non-PV triggers.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical relevance of left atrial structural remodeling and non-pulmonary vein foci in atrial fibrillation.\",\"authors\":\"Atsuhiko Yagishita, Susumu Sakama, Kazuma Iimura, Kyong Hee Lee, Kengo Ayabe, Mari Amino, Yuji Ikari, Koichiro Yoshioka\",\"doi\":\"10.1007/s10840-024-01931-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The mechanistic role of left atrial (LA) structural remodeling as a non-pulmonary vein (PV) trigger in the initiation of atrial fibrillation (AF) remains uncertain. This study is aimed at prospectively evaluating the association between non-PV triggers and LA structural remodeling.</p><p><strong>Methods: </strong>A total of 517 patients undergoing catheter ablation for AF were included. After PV isolation, a standardized protocol was implemented to reveal non-PV triggers, which included burst pacing into AF followed by cardioversion during isoproterenol infusion. If pacing-induced atrial tachycardia (AT) was observed, mapping and catheter ablation were performed.</p><p><strong>Results: </strong>The mean percentage of LA low-voltage area (LVA) < 0.5 mV incrementally increased during right atrial pacing among the no induction (n = 470), AF (n = 21), and AT (n = 26) groups (2.6 ± 5.7%, 5.5 ± 6.4%, and 18.0 ± 21.5%, respectively; P < 0.001). In the AF induction group, non-PV foci originated from the left atrium in 13 of 25 foci (52%), and 8 of 13 LA non-PV foci (62%) were located in the septal region. All except 1 focus originated from the non-LVA < 0.5 mV (8%), but 8 of the 13 LA foci originated from the LVA < 1.0 mV (62%). There were no differences in AF recurrence among the groups (log-rank, P = 0.160).</p><p><strong>Conclusion: </strong>The majority of non-PV foci in the LA originated outside regions with advanced structural remodeling, thus suggesting the limited effectiveness of adjunctive ablation guided by the LVA < 0.5 mV during sinus rhythm in eliminating non-PV triggers.</p>\",\"PeriodicalId\":16202,\"journal\":{\"name\":\"Journal of Interventional Cardiac Electrophysiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-10-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Interventional Cardiac Electrophysiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10840-024-01931-7\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Interventional Cardiac Electrophysiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10840-024-01931-7","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Clinical relevance of left atrial structural remodeling and non-pulmonary vein foci in atrial fibrillation.
Background: The mechanistic role of left atrial (LA) structural remodeling as a non-pulmonary vein (PV) trigger in the initiation of atrial fibrillation (AF) remains uncertain. This study is aimed at prospectively evaluating the association between non-PV triggers and LA structural remodeling.
Methods: A total of 517 patients undergoing catheter ablation for AF were included. After PV isolation, a standardized protocol was implemented to reveal non-PV triggers, which included burst pacing into AF followed by cardioversion during isoproterenol infusion. If pacing-induced atrial tachycardia (AT) was observed, mapping and catheter ablation were performed.
Results: The mean percentage of LA low-voltage area (LVA) < 0.5 mV incrementally increased during right atrial pacing among the no induction (n = 470), AF (n = 21), and AT (n = 26) groups (2.6 ± 5.7%, 5.5 ± 6.4%, and 18.0 ± 21.5%, respectively; P < 0.001). In the AF induction group, non-PV foci originated from the left atrium in 13 of 25 foci (52%), and 8 of 13 LA non-PV foci (62%) were located in the septal region. All except 1 focus originated from the non-LVA < 0.5 mV (8%), but 8 of the 13 LA foci originated from the LVA < 1.0 mV (62%). There were no differences in AF recurrence among the groups (log-rank, P = 0.160).
Conclusion: The majority of non-PV foci in the LA originated outside regions with advanced structural remodeling, thus suggesting the limited effectiveness of adjunctive ablation guided by the LVA < 0.5 mV during sinus rhythm in eliminating non-PV triggers.
期刊介绍:
The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.