| Objective:Our study aimed to find the association between the change of pulmonary vein potential amplitude (PVPA) and the ablation energy delivery time, as well as to assess the efficacy of various ablation strategies based on pulmonary vein potential in patients with atrial fibrillation (AF).Methods:We enrolled consecutive patients with AF from Janunary 2013 to November 2015 in the Department of Cardiology, PLA General Hospital, who finally finished radiofrequency catheter ablation (RFCA). All cases completed scheduled follow-up. Basic demographic information, various clinical characteristics and laboratory results were recorded and analysed. According to different ablation strategies, patients were divided into five groups, which were conventional ablation group (CAG, n=69), pulmonary vein ablation group (PVAG, n=48), enhanced ablation group (EAG, n=25),2 circles+3 lines group (2C3LG, n=31) and pulmonary vein antrum+gangllonated plexuses+pulmonary vein musculature ablation group (3PG, n=7). Pulmonary vein antrum (PVA) isolation was achieved by creating a single ablation circle at the PVA in CAG and closely created double ablation circles at PVA in EAG In PVAG, we isolated each pulmonary vein opening. Increased linear ablation at the top of the left atrium, tricuspid isthmus and mitral isthmus in 2C3L group based on CAG, and increased linear ablation at pulmonary vein musculature in 3PG based on EAG Regular Holter monitorings were used to follow up all patients. The linear regression model was utilized to assess the relationship between PVPA and ablation energy delivery time. Log-rank test was used to evaluate the efficacy of various ablation strategies based on pulmonary vein potential in patients with atrial fibrillation.Results:Total 180 cases with AF were enrolled in this study.?There were no significant differences in clinical characteristics among these five groups (p>0.05).? Positive correlation between PVPA and ablation energy delivery time wad found (r=0.92,p<0.01).?No significant difference existed between paroxysmal AF CAG and persistent AF group in PVPA and ablation energy delivery time (p>0.05). ?AF recurrence-free rate at 12 months in sub-groups of paroxysmal AF and persistent AF was 82.4% and 44.4%, respectively (p<0.05). ?Ablation energy delivery time in CAG was longer than in EAG (45.66±6.59 min vs.40.10±3.48 min,p<0.01). There were no significant differences in fluoroscopy, procedure time and NT-proBNP level between those two groups. During the follow-up of 19.3±5.6 months, AF recurrence rate was higher in CAG than in EAG (8.00% vs.33.33%, p<0.05). Reconnection between left artium and PV was confirmed in re-ablation procedures.? During the follow-up of 12 months, sinus rhythm mantainence was significant different among CAD, PVAG, EAG,2C3LG and 3PG (63.77% vs.64.58% vs.92.00% vs.83.87% vs.85.71%, p<0.05). In sub-group of paroxysmal AF, there were also difference in sinus mantainence among these five groups (64.91% vs.71.05% vs. 94.74% vs.83.33% vs.100.00%, p<0.05). But in sub-group of persistent AF, no significant difference existed among groups of CAD, PVAG, EAG,2C3LG and 3PG(43.75% vs.40.00% vs.83.33% vs.85.71% vs.66.67%, p>0.05).Conclusion:Our study found that PVPA can be used to direct radiofrequency ablation for all kinds of clinical AFs. We also disconvered that enhanced PVA ablation techiniques based on PVP could improve long-term outcomes of AF. |
PDF Full Text Request