Prognostic Value of Inferior Shift of P wave Axis after Catheter Ablation for Longstanding Persistent Atrial Fibrillation based on Dallas Lesion Set Including Anterior Line
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Objectives: Although an anterior linear ablation is an effective lesion set in radiofrequency catheter ablation (RFCA) for longstanding persistent atrial fibrillation (L-PeAF), its durability for bidirectional block (BDB) is only about 60% at repeat procedure. We hypothesized that changes in electrocardiogram (ECG) may predict an anterior line block state and the clinical outcome of L-PeAF ablation. Subjects and Methods: We studied 304 L-PeAF patients (77% male, 60±10yrs), who consistently underwent RFCA Dallas lesion set (circumferential pulmonary vein isolation, posterior box lesion, and anterior line) protocol with subsequent comparison of pre-procedural and post-procedural P wave axes, and one year follow-up (n=205) sinus rhythm (SR) ECGs. Results: 1. P wave axis shifted inferiorly at immediate post-procedure (p<0.001), and was independently correlated with BDB of anterior line (ß=10.4, 95% confidence interval [CI] 2.79–17.94, p=0.008). 2. The degree of post-procedural inferior shift of P wave axis did not reflect clinical recurrence within one-year (n=205, p=0.923), potentially due to conduction recovery of an anterior line. However, among 160 patients without clinical recurrence within one-year, P wave axis at one-year ECG was independently associated with very late recurrence of AF after one-year (n=160, hazard ratio [HR] 0.98; 95% CI 0.97–0.99, p=0.001), during 45.6±16.7 months of follow-up. 3. Among 22 patients who underwent repeat procedures, P wave axis shift was more significant in patients with maintained BDB of an anterior line than in those without (p=0.015). Conclusion: An inferior shift of P wave axis reflects the achievement and the maintenance of an anterior line BDB, and is associated with better long-term clinical outcome after catheter ablation for L-PeAF based on Dallas lesion set.
Abstract
Background and Objectives: Although an anterior linear ablation is an effective lesion set in radiofrequency catheter ablation (RFCA) for longstanding persistent atrial fibrillation (L-PeAF), its durability for bidirectional block (BDB) is only about 60% at repeat procedure. We hypothesized that changes in electrocardiogram (ECG) may predict an anterior line block state and the clinical outcome of L-PeAF ablation. Subjects and Methods: We studied 304 L-PeAF patients (77% male, 60±10yrs), who consistently underwent RFCA Dallas lesion set (circumferential pulmonary vein isolation, posterior box lesion, and anterior line) protocol with subsequent comparison of pre-procedural and post-procedural P wave axes, and one year follow-up (n=205) sinus rhythm (SR) ECGs. Results: 1. P wave axis shifted inferiorly at immediate post-procedure (p<0.001), and was independently correlated with BDB of anterior line (ß=10.4, 95% confidence interval [CI] 2.79–17.94, p=0.008). 2. The degree of post-procedural inferior shift of P wave axis did not reflect clinical recurrence within one-year (n=205, p=0.923), potentially due to conduction recovery of an anterior line. However, among 160 patients without clinical recurrence within one-year, P wave axis at one-year ECG was independently associated with very late recurrence of AF after one-year (n=160, hazard ratio [HR] 0.98; 95% CI 0.97–0.99, p=0.001), during 45.6±16.7 months of follow-up. 3. Among 22 patients who underwent repeat procedures, P wave axis shift was more significant in patients with maintained BDB of an anterior line than in those without (p=0.015). Conclusion: An inferior shift of P wave axis reflects the achievement and the maintenance of an anterior line BDB, and is associated with better long-term clinical outcome after catheter ablation for L-PeAF based on Dallas lesion set.
참고문헌 (20)
- Kirchhof P, "2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: the Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC):developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC: endorsed by the European Stroke Organisation (ESO)", Europace, 18, pp.1609~1678 (2016)
- Wynn GJ, "Efficacy of catheter ablation for persistent atrial fibrillation : a systematic review and meta-analysis of evidence from randomized and nonrandomized controlled trials", Circ Arrhythm Electrophysiol, 7, pp.841~852 (2014)
- Pak HN, "Comparison of voltage map-guided left atrial anterior wall ablation versus left lateral mitral isthmus ablation in patients with persistent atrial fibrillation", Heart Rhythm, 8, pp.199~206 (2011)
- Edgerton JR, "Totally thorascopic surgical ablation of persistent AF and long-standing persistent atrial fibrillation using the "Dallas" lesion set", Heart Rhythm, 6, pp.S64~S70 (2009)
- Tilz RR, "Catheter ablation of long-standing persistent atrial fibrillation : 5-year outcomes of the Hamburg Sequential Ablation Strategy", J Am Coll Cardiol, 60, pp.1921~1929 (2012)
- European Heart Rhythm A, "Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)", Eur Heart J, 31, pp.2369~2429 (2010)
- Park JK, "Low P-wave amplitude (<0.1 mV) in lead I is associated with displaced interatrial conduction and clinical recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation", Europace, 18, pp.384~391 (2016)
- Park J, "Prolonged PR interval predicts clinical recurrence of atrial fibrillation after catheter ablation", J Am Heart Assoc, 3, pp.e001277~ (2014)
- Blanche C, "Value of P-wave signal averaging to predict atrial fibrillation recurrences after pulmonary vein isolation", Europace, 15, pp.198~204 (2013)
- Park JH, "The relationship between endocardial voltage and regional volume in electroanatomical remodeled left atria in patients with atrial fibrillation: comparison of three-dimensional computed tomographic images and voltage mapping", J Cardiovasc Electrophysiol, 20, pp.1349~1356 (2009)
- Kim TH, "Linear ablation in addition to circumferential pulmonary vein isolation (Dallas lesion set) does not improve clinical outcome in patients with paroxysmal atrial fibrillation: a prospective randomized study", Europace, 17, pp.388~395 (2015)
- Calkins H, "2012 HRS", EHRA, Europace, pp.2012, 14[DOI]
- Holmqvist F, "Interatrial conduction can be accurately determined using standard 12-lead electrocardiography : validation of P-wave morphology using electroanatomic mapping in man", Heart Rhythm, 5, pp.413~418 (2008)
- Lim TW, "P-wave measurements and electrical reconnection of the posterior left atrium after catheter ablation for atrial fibrillation", Pacing Clin Electrophysiol, 33, pp.1324~1334 (2010)
- Ogawa M, "Reduction of P-wave duration and successful pulmonary vein isolation in patients with atrial fibrillation", J Cardiovasc Electrophysiol, 18, pp.931~938 (2007)
- Ho SY, "Atrial structure and fibres : morphologic bases of atrial conduction", Cardiovasc Res, 54, pp.325~336 (2002)
- Ariyarajah V, "The Bachmann Bundle and interatrial conduction", Cardiol Rev, 14, pp.194~199 (2006)
- Waldo AL, "Effects on the canine P wave of discrete lesions in the specialized atrial tracts", Circ Res, 29, pp.452~467 (1971)
- Sanders P, "Electrophysiologic and clinical consequences of linear catheter ablation to transect the anterior left atrium in patients with atrial fibrillation", Heart Rhythm, 1, pp.176~184 (2004)
- Markides V, "Characterization of left atrial activation in the intact human heart", Circulation, 107, pp.733~739 (2003)