查看更多>>摘要：目的 探究老年阵发性心房颤动（房颤）患者非肺静脉触发灶的临床特征及消融对预后的影响。 方法 本研究为回顾性队列研究。纳入2018年1月至2021年6月在南京医科大学第一附属医院心内科首次行射频导管消融的老年阵发性房颤患者。所有患者均在三维标测系统下成功行环肺静脉隔离（CPVI）及左心房基质标测，如合并低电压同时行基质改良，术中如果发现非肺静脉触发灶，同时进行消融。记录术中发现的非肺静脉触发灶的数量和分布。术后复发的定义为单次消融术后，空白期过后的临床随访中通过心电图记录或动态心电图记录到持续>30 s的房性快速性心律失常（ATA）。 结果 共入选738例患者，其中男385例，年龄（70.0±3.9）岁，年龄范围65~80岁，病程中位数为24个月。根据有无记录到非肺静脉触发灶将患者分为未记录到非肺静脉触发灶组（组Ⅰ，n=679），记录到非肺静脉触发灶组（组Ⅱ，n=59），两组间临床资料差异无统计学意义（P>0.05）。非肺静脉触发灶在老年阵发性房颤患者中的发生率约为8%，主要分布在上腔静脉（49.3%，33/67）、界嵴（14.9%，10/67）、卵圆窝（11.9%，8/67）等。组Ⅰ较组Ⅱ患者低电压区比例高，但差异无统计学意义[37.1%（252/679）对28.8%（17/59），P=0.204]。消融术后随访14.0（12.0，26.2）个月，两组间成功率相近，差异无统计学意义[74.9%（484/646）对71.9%（41/57），P=0.459]。 结论 老年阵发性房颤患者非肺静脉触发灶发生率较低，且主要分布于上腔静脉，CPVI联合非肺静脉触发灶消融有满意的疗效。 Objective To investigate the prevalence, clinical characteristics and outcomes of non-pulmonary vein (PV) triggers in older patients with paroxysmal atrial fibrillation (PAF) . Methods This is a retrospective cohort study. Older patients with PAF who underwent their first catheter ablation at the Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University from January 2018 to June 2021 were enrolled. All patients underwent a successful circumferential pulmonary vein isolation (CPVI) procedure guided by 3D mapping system. If low-voltage areas (LVA) were detected within the left atria, substrate modification was applied. Additional ablation was performed simultaneously if non-PV triggers were spontaneously presented or induced by programmed and pharmacological stimulation. The prevalence and distribution of non-PV triggers were documented. The primary endpoint of the study was freedom from atrial tachyarrhythmia (ATA) as determined by electrocardiogram documentation or lasting longer than 30 s during Holter recordings following a single-ablation procedure. Results The study included 738 older patients with PAF [385 males, mean age (70.0±3.9) years]. Among them, 679 patients did not exhibit non-PV triggers (Group I), while 59 patients showed non-PV triggers (Group Ⅱ). There were no statistically significant differences in baseline characteristics between the two groups (P>0.05). The incidence of non-PV triggers in older patients with PAF was approximately 8%, with the most prevalent locations being the superior vena cava (49.3%, 33/67), the crista terminalis (14.9%, 10/67), and the fossae ovalis (11.9%, 8/67). Additionally, non-PV triggers were found in other areas, including the left atrial appendage, septum, right atrial appendage, posterior wall of the left atrium, coronary sinus, free wall of the right atrium, persistent left superior vena cava, mitral annulus, and the roof of the left atrium. The proportion of LVA was similar between the two groups [37.1% (252/679) vs. 28.8% (17/59),P=0.204]. After a follow-up of 14.0 (12.0, 26.2) months, there was no significant difference in the rate of freedom from ATA recurrence between Group I and Group Ⅱ [74.9% (484/646) vs. 71.9% (41/57), P=0.459] . Conclusion The prevalence of non-PV triggers in older patients with paroxysmal AF was relatively low and mainly located in the superior vena cava. Clinical outcome of ablation of non-PV triggers after CPVI combined with non-pulmonary vein triggers ablation is promising.
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