| Objective At present, mechanism of atrial fibrillation is unclear; Persistent atrialfibrillation ablation strategy is not unified; Atrial flutter and atrial tachycardia highlyhas been Occurred after ablation; Long-standing persistent atrial fibrillation ablation hasa high rate of recurrence. The passage has a further discussion the correlation betweenserum PIIINP expression level and substrate mapping of left atrial in different types ofpatients with atrial fibrillation.Method49cases of patients with atrial fibrillation are selected as paroxysmal atrialfibrillation (Paroxysmal atrial fibrillation, Pa-Af) group，41patients as persistent atrialfibrillation (Persistent atrial fibrillation, Pe-Af) group and30patients as a long-standingpersistent atrial fibrillation (long-standing persistent atrial fibrillation, Lsp-Af) groupwho have accepted ablation for the treatment guided Ensite navx system. The sameperiod select ablation of paroxysmal supraventricular tachycardia (left side of pathwaysinvolved in exhumation)43patients as a control group. Preoperative PIIINP expressionlevels in the serum were measured by enzyme-linked immunosorbent assay. Substratemapping of Left atrial (Low voltage point is defined as a bipolar voltage of0.1~0.5mV,scar point is defined as a bipolar voltage <0.1mV)were measured during surgery insinus rhythm, showed left atrial low-voltage distribution points and scar point area ofeach group, measured low voltage and scar area accounted for the proportion of leftatrial area. For the control group of patients, similarly method measured low voltage and scar area accounted for the proportion of left atrial area after Theelectrophysiological confirm the left pathways involved in the exhumation.Result1Serum PIIINP expression levels and left atrial low voltage and scar arearatio are lower in the control group than paroxysmal AF and persistent AF group andlong-standing persistent AF group. The difference in serum PIIINP expression levelsand low voltage and scar area ratio of the left atrium not have statistically significant;Incontrast to the long-standing persistent AF group, the serum PIIINP expressionlevels,and low voltage and scar area ratio of the left atrium of paroxysmal AF are low.But in contrast to the long-standing persistent AF group, the serum PIIINP expressionlevels and low voltage and scar area ratio of the left atrium of persistent AF are low.2The serum PIIINP expression levels and low voltage and scar area ratio of the leftatrium in each group was positively correlated.Conclusions1Paroxysmal atrial fibrillation, persistent atrial fibrillation andlong-term persistent atrial fibrillation compared with the control group myocardialfibrosis and left atrial substrate change serious. Prompted myocardial fibrosis and leftatrial substrate change may be involved in the occurrence and maintenance of atrialfibrillation.2No significant difference in myocardial fibrosis and left atrial substratechanges have occered in paroxysmal atrial fibrillation and persistent atrial fibrillation.Implied both radiofrequency ablation strategy may be basically the same. But thelong-standing persistent atrial fibrillation in myocardial fibrosis and left atrial substratechange have lighter than paroxysmal atrial fibrillation. Prompted to choose along-standing persistent atrial fibrillation ablation strategy should be distinguished fromparoxysmal and persistent atrial fibrillation. The purely bilateral pulmonary veinisolation may not completely undermine the maintenance of atrial fibrillation substrate.Whether it should be changed further to be atrial substrate ablation and how ablation are electrophysiological doctor solved the problem.3Serum PIIINP level of left atrial lowvoltage and scar area ratio was positively correlated with tips myocardial fibrosis andatrial matrix process of change may have overlapping mechanisms. |
