成功分离肺静脉入口之后腺苷对心房-静脉传导的恢复作用

作     者：Tritto M. De Ponti R. Salerno-Uriarte J.A. 宁宁 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第5期

页      面：37-38页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：恢复作用 射频电流 传导时间 随机试验 

摘      要：Pulmonary vein(PV) isolation is a curative treatment for patients with atrial fibrillation. The aim of this study was to evaluate prospectively the effects of adenosine administration on the PV activity and atrio-venous conduction after PV isolation. Twenty-nine patients(21 m; age: 55±8 years) were submitted to ostial PV isolation guided by basket catheter recordings. After successful isolation, the effects of a 12 mg intravenous bolus of adenosine were tested in 62 PVs. In 22/62 PVs (35%), left atrium(LA)-to-PV conduction was transiently (16.6±7.1 s, range: 3.8-27.9 s) or permanently(3 PVs) restored in response to adenosine administration. The prevalence of this phenomenon was 39%in left superior PVs, 43%in right superior PVs, and 22%in left inferior PVs(p=0.365). It occurred more frequently in the presence of dissociated PV activity (11/15 PVs, 73%vs. 11/47 PVs, 23%; p=0.002), whereas it was not influenced by the median duration of the radiofrequency current (RFC) delivery for each PV [19 (IQR: 12-26) min vs. 16 (IQR: 11-24) min; p=0.636]. A lengthening or shortening of the LA-PV conduction time was observed at LA-PV conduction appearance and disappearance in 36%and 55%of the cases, respectively. Further RFC applications(median: 5.5 min, IQR: 4-11 min) at the residual conduction breakthrough(s) indicated by the basket catheter recordings definitively eliminated adenosine-induced recovery of LA-PV conduction in all cases. Finally, when present, intrinsic PV discharge was invariably depressed by adenosine administration. Adenosine may transiently or permanently re-establish LA-PV conduction after apparently successful PV isolation. This phenomenon is abolished by additional RFC delivery. However, its possible influence on the clinical results of PV ablation must be evaluated by properly designed, randomized studies.