Persistent atrial fibrillation ablation in cardiac laminopathy: Electrophysiological findings and clinical outcomes

医学 心脏病学 烧蚀 心房颤动 内科学 窦性心律 导管消融
作者
Rémi Chauvel,Nicolas Derval,Josselin Duchâteau,Arnaud Denis,Romain Tixier,Nicolas Welté,Clémentine André,F. Daniel Ramirez,Takashi Nakashima,Yosuke Nakatani,Tsukasa Kamakura,Takamitsu Takagi,Philipp Krisai,Ghassen Cheniti,Konstantinos Vlachos,Félix Bourier,Masateru Takigawa,Τakeshi Kitamura,Frédéric Sacher,Mélèze Hocini,Pierre Jaı̈s,Michel Haı̈ssaguerre,Thomas Pambrun
出处
期刊:Heart Rhythm [Elsevier BV]
卷期号:18 (7): 1115-1121 被引量:4
标识
DOI:10.1016/j.hrthm.2021.03.040
摘要

Little is known about persistent atrial fibrillation (AF) ablation in patients with cardiac laminopathy (CLMNA).We aimed to characterize atrial electrophysiological properties and to assess the long-term outcomes of persistent AF ablation in patients with CLMNA.All patients with CLMNA referred in our center for persistent AF ablation were retrospectively included. Left atrial (LA) volume, left atrial appendage (LAA) cycle length, interatrial conduction delay, and LA voltage amplitude were analyzed during the ablation procedure. Sinus rhythm maintenance and LA contractile function were assessed during long-term follow-up.From 2011 to 2020, 8 patients were included. The mean age was 47 ± 14 years, and 3 patients (38%) were women. The LA volume was 205.8 ± 43.7 mL; the LAA AF cycle length was 250.7 ± 85.6 ms; and the interatrial conduction delay was 296.5 ± 110.1 ms. Large low-voltage areas (>50% of the LA surface; <0.5 mV electrogram) were recorded in all 8 patients. Two patients had inadvertent LAA disconnection during ablation. All A waves recorded by pulsed Doppler in sinus rhythm were <30 cm/s before and after AF ablation. Early arrhythmia recurrence was recorded in 7 patients (87%) (time to recurrence 4 ± 4 months; 1.5 procedures per patient). After a mean follow-up of 4.4 ± 3.2 years, 4 patients underwent implantable cardioverter-defibrillator therapy for life-threatening ventricular arrhythmia and 3 patients finally underwent heart transplantation.Patients with persistent AF afflicted by CLMNA exhibit severe LA impairment because of large low-voltage areas, prolonged conduction velocity, and reduced contractile function. Ablation procedures have a limited effect with a high recurrence rate.
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