| Purpose:Atrial fibrillation(AF)is one of the most common clinical arrhythmia.Quality of life could be significantly reduced in patients with AF.The catheter radiofrequency ablation of atrial fibrillation has become the main treatment of drug refractory atrial fibrillation.For persistent atrial fibrillation,guideline recommends on the basis of circle pulmonary vein isolation affiliated substrate modification,including the top of the left atrium line ablation,mitral isthmus line ablation,and tricuspid isthmus line ablation.However,a recent study demonstrated that additional ablation could not increase the success rate of ablation.On the contrast,it may increase additional procedure time and complication risk.Meanwhile,little is known about whether tricuspid valve line ablation could increase successful rate.This study aims to study the characteristics of tricuspid conduction in patients with different types of atrial fibrillation so as to provide some clues for tricuspid annulus isthmus ablation during the catheter ablation for atrial fibrillation.Method:Patients who underwent Catheter Radiofrequency Ablation(RFCA)for paroxysmal supraventricular tachycardia,pre-excitation syndrome,paroxysmal AF and persistent AF with or without typical atrial flutter were recruited at the First Hospital Affiliated to Dalian medical university between December 2015 and October 2016.Patients with hyperthyroidism,atrial thrombus,severe liver and kidney dysfunction or AF due to moderate heart valve stenosis were excluded.In addition,any patients who has had multiple RFCAs,mitral valve replacement or extensive atrial scar tissues were also excluded from this study.All patients were divided into three groups,including control group(PSVT)and AF group(paAF and peAF).We conducted atrial electro-anatomical mapping on all patients and recorded tricuspid annulus isthmus conduction time(ICT)and tricuspid annular conduction time(TCT)during coronary sinus proximal pacing with a 600ms circle length by ablative catheter.ICT was defined as conduction time fom 5:30 to 7:30 at LAO 45°.TCT is considered as(Tmax-Tmin)x2 in tricuspid valve annulus.ICP =ICT/TCT.ICT,TCT,and ICP were compared among three groups Result:1.The patient demographics,such as age,gender,blood pressure and diabetics were compared among different groups.No significant differences were found(P>0.05).2.When compared to the control,AF group had a significant increase in their TCT values(P<0.05).However,no significant differences were found between the paAF and control groups(P =0.153).Within the AF groups,the peAF subgroups showed significantly longer TCT compared to the paAF subgroup(P<0.05).TCT values were 68.47±21.3,63.74 ± 19.23 and 87.48±17.68 in the control,paAF and peAF groups.3.The AF group had significantly longer ICT delay compared to the contrl(P<0.05).In addition,the conduction speed of the peAF group was significantly reduced compared to the control.Within the AF group,the paAF subgroup was significantly longer than the paAF subgroup(P<0.05).ICT values were 23.31±17.61,26.17 ±19.43 and 53.26 ±21.90 in the control,paAF and peAF groups.4.The ICP was significantly raised in the AF group when compared to the control(P<0.05).Moreover,the conduction velocity was significantly reduced in the peAF group when compared to the control(P<0.05).Within the AF subgroup,peAF subgroup was significantly longer than the paAF subgroup(P<0.05).ICP values were 0.194 ±0.0642,0.267 ±0.0771 and 0.372±0.0712 in the control,paAF and peAF groups.Conclusion:1.Prolonged ICT and TCT in AF patients,especially in persistent AF patients indicated that AF,especially persistent AF could result in right atrial remodeling.2.Increased ICP in AF patients,especially in persistent AF patients indicated that ICT may be contribute to prolonged TCT.3.The results provides some clues that tricuspid annulus isthmus ablation during AF ablation may be useful for AF patients with increased ICP. |
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