| Background: Atrial fibrillation(AF)is one of the most commonly-seen arrhythmias clinically,which can greatly increase the risk of stroke,heart failure and other diseases.With the continuous study of the mechanism of AF,currently it is considered that pulmonary vein(PV)muscle sleeve trigger is one of the important mechanisms leading to spontaneous AF.Therefore,circumferential pulmonary vein isolation(CPVI)realized by radiofrequency catheter ablation(RFCA),has become a cornerstone of the treatments for different types of AF,especially for paroxysmal atrial fibrillation(PAF).Nevertheless,for the catheter ablation of persistent atrial fibrillation(Per AF)and long-term persistent atrial fibrillation,there is no clear and unified treatment strategy.As a result,various combined ablation strategies of different additional sites based on CPVI were generated.Generally speaking,although catheter ablation operations are different from one another,their clinical success rate is much lower than that of catheter ablation of PAF.The results from recent studies have shown that AF patients’ left atrial fibrosis of different degrees has a certain relationship with occurrence and maintenance of AF.The left atrial low voltage zone(LVZ)detected by a three-dimensional electroanatomical mapping system is closely related to left atrial fibrosis.Therefore,this study aims to observe the success rate of Per AF catheter ablation on the basis of CPVI combined with the substrate modification of left atrial LVZ.Objective: The aim of this study was to compare safety and efficacy of single CPVI for Per AF with those of CPVI combined with the substrate modification of left atrial LVZ under sinus rhythm,as well as the differences among related indexes of operations,such as ablation discharge time,fluoroscopy time,irradiation dose and so on.Methods: The Per AF(including long-term persistent atrial fibrillation)patients who firstly underwent the catheter ablation operations in Cardiovascular Internal Medicine,Yijishan Hospital,Wannan Medical College from January in 2018 to December in 2019 were selected as research objects.They were randomly divided into study group and control group.The left atrial three-dimensional anatomical model was constructed under the guidance of CARTO3 to complete the CPVI.Then a Penta Ray or LASSO diagnostic catheter was used for high density mapping under sinus rhythm,and the zone with bipolar voltage from 0.1m V to 0.5m V was defined as a low voltage zone,below 0.1 m V was defined as a scar zone.If there is LVZ in the study group,it is called the LVZ modified group.According to the location of LVZ distribution and the area of the low voltage zone,an individualized ablation strategy is designed.If there is LVZ in the control group,without any intervention,it is called the unmodified LVZ group.The baseline data concerning sex,age,BMI,hypertension,left atrial diameter(LAD),left ventricular ejection fraction(LVEF)and so on were collected preoperatively.After the operation,ablation discharge time,irradiation dose,X-ray fluoroscopy time and perioperative complications were compared between the two groups.The patients were followed up by telephone,outpatient and hospitalization for12 months,and followed up by 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram in the 3rd,6th and 12 th months.The atrial arrhythmia such as atrial fibrillation(AF)/ atrial flutter(AFL)/ atrial tachycardia(AT)occurred 3 months after ablation with the duration longer than 30 seconds,the recurrence can be affirmed.Then the follow-up results will be sorted out,compared and analyzed for observing the difference of success rates between the two groups in one year after radiofrequency ablation.Results:152 Per AF patients(including those with long-term Per AF)were included in this study.Before operation,the patients were randomly divided into two groups: study group(N=78)and control group(N=74).There were 40 patients with LVZ(40/78)in the study group,and 36 patients with LVZ(36/74)in the control group.The results showed that the ablation discharge time of the LVA+SM group was longer than that of the LVA without SM comparison group(68.88±4.71 vs 58.08±3.69 min,P<0.05);the irradiation dose between two groups was of no statistical significance(60.93±1.25 vs60.61±1.29 m Gy,P>0.05);there was no significant difference in the fluoroscopy time between two groups(8.93±1.05 vs8.58±1.08 min,P>0.05).The results from 12-month follow-up data showed that the sinus rhythm maintenance rate of the LVA+SM group was higher than that of the LVA without SM comparison group in one year after operation(77.5% vs47.2% P<0.05).In the LVA+SM group,there was 1pseudoaneurysms of right femoral artery occurred,while 1 cardial tamponade occurred in the LVA without SM comparison group.The incidence of complications in atrial fibrillation ablation was similar(2.5% vs2.8% P>0.05).Conclusion: Firstly,for the persistent atrial fibrillation patients with low-voltage zones,the left atrial substrate modification under sinus rhythm conducted after CPVI compared with the single CPVI can improve the in-one-year success rate after operation;secondly,X-ray fluoroscopy time and the incidence of perioperative complications of CPVI combined with left atrial substrate modification under sinus rhythm are similar with those of the former,so it is one of safe and effective surgical strategies for ablation of patients with persistent atrial fibrillation. |
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