| Objective AF(atrial fibrillation)is a common type of arrhythmia.Catheter ablation is currently the only method to cure AF.It is now widely believed that paroxysmal AF originates from the ectopic triggers in pulmonary veins,and PVI(pulmonary vein isolation)plays a role as the cornerstone of the paroxysmal AF ablation.Recent studies have found rotor in patients with AF,and rotor ablation can terminate AF immediately.Since last year,our center has carried out a new procedure,ablating rotor after PVI,to treat paroxysmal AF.We use dispersion mapping to locate rotors and focal sources.In this retrospective study,we evaluated the early recurrence rate within 3 months after the ablation(blanking period),analyzed the factors affecting early postoperative recurrence and explored its possible predictive factors.Method Subjects of this study were patients with paroxysmal AF undergoing ablation from May 2017 to October 2017 in Shanghai Chest Hospital.A total of 212 patients were included and 172 patients completed followed-ups.Among them,87 underwent PVI first.Dispersion mapping and rotor ablation was planned then.These patients were included in the dispersion group.The other 85 patients underwent PVI alone and were included in the conventional group.In the dispersion group,only part of patients could induce stable AF after PVI,allowing subsequent dispersion mapping and rotor ablation.These patients further formed the rotor subgroup.The remaining patients could not induce stable AF and only took PVI.They form the pulmonary vein subgroup.By checking the surgical records,dispersion mapping results of patients from rotor subgroup were counted,and the areas of rotor distribution were analyzed.Through outpatient reviews and telephone follow-ups,the early recurrence of all patients within 3 months after ablation was evaluated,and the difference between the early recurrence rate in the dispersion group and the conventional group was compared.Perioperative data were collected and the factors affecting the early recurrence rate in the rotor group were screened by univariate analysis and logistic multivariate analysis.Results Intraoperative dispersion mapping results in rotor subgroup showed that the most common location of rotors and focal sources in the paroxysmal AF were pulmonary vein related regions.The most common location outside the pulmonary vein was the roof of the LA(left atrium).Right atrium,however,is less likely to map rotors.Followup results suggested that the early recurrence rate in the dispersion group was 35.6% within 3 months after ablation,and the early recurrence rate in the conventional group was 41.2%.The early recurrence rate in the dispersion group was lower than that in the conventional group,but the difference was not significant(P =0.455).The early recurrence rate in the subgroup of the rotor was 26.3%,which was lower than that in the dispersion group and the conventional group,but there was no significant difference(P=0.114 and P=0.307,respectively).Logistic multivariate analysis showed that CRP on the first day after ablation was an independent risk factor for no early recurrence.Conclusion This study confirms that dispersion mapping can indeed locate rotor in patients with paroxysmal AF.In this stage,pulmonary vein related regions are the most important sites for the distribution of AF drivers(rotors and focal sources).Ablation of the rotor following conventional PVI can reduce the rate of early recurrence,but its significance requires more extensive retrospective studies or randomized controlled trials.CRP on the first day after ablation is an independent risk factor for no early recurrence. |
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