李蕾,刘书旺

• 1:北京大学第三医院心内科

摘要(Abstract)：

<正>心房颤动(atrial fibrillation,AF,房颤)是最常见的持续性心律失常,心力衰竭和卒中是房颤致残和致死的首要原因。房颤及其并发症给人民健康和国民经济造成了沉重负担[1-3]。Ha?ssaguerre等[4]发起的一系列里程碑式研究,揭示肺静脉电位是房颤重要的触发和维持机制,奠定了肺静脉消融治疗房颤的理论基础。现行临床指南和专家共识均推荐肺静脉和(或)肺静脉-心房隔离作为药物难治症状性房颤的I类适应证。肺静

关键词(KeyWords)： 心房颤动;腺苷试验;肺静脉-左心房隐匿性传导

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(31700674)

作者(Author): 李蕾,刘书旺

参考文献(References)：

• [1]Goette A,Kalman JM,Aguinaga L,et al.EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies:Definition,characterization,and clinical implication.Heart Rhythm,2017,14(1):e3-e40.
• [2]January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRSguideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.J Am Coll Cardiol,2014,4(21):2305-2307.
• [3]Kirchhof P,Benussi S,Kotecha D,et al.2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.Europeace,2016,18(11):1609-1678.
• [4]Ha?ssaguerre M,Ja?s P,Shah DC,et al.Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.N Engl J Med,1998,339(10):659-666.
• [5]Packer DL,Kowal RC,Wheelan KR,et al.Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation:first results of the North American Arctic Front(STOP AF)pivotal trial.J Am Coll Cardiol,2013,61(16):1713-1723.
• [6]Morillo CA,Verma A,Connolly SJ,et al.Radiofrequency ablation vs.antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation(RAAFT-2):a randomized trial.JAMA,2014,311(7):692-700.
• [7]Kuck KH,Brugada J,Fürnkranz A,et al.Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation.N Engl JMed,2016,374(23):2235-2245.
• [8]Calkins H,Reynolds MR,Spector P,et al.Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation:two systematic literature reviews and meta-analyses.Circ Arrhythm Electrophysiol,2009,2(4):349-361.
• [9]Ouyang F,Antz M,Ernst S,et al.Recoveredpulmonaryveinconduct ion as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins:lessons from double Lasso tech-nique.Circulation,2005,111(2):127-135.
• [10]Verma A,Mantovan R,Macle L,et al.Substrate and Trigger Ablation for Reduction of Atrial Fibrillation(STAR AF):a randomized,multicentre,international trial.Eur Heart J,2010,31(11):1344-1356.
• [11]Datino T,Macle L,Qi XY,et al.Mechanisms by which adenosine restores conduction in dormant canine pulmonary veins.Circulation,2010,121(8):963-972.
• [12]Kumar N,Dinh T,Phan K,et al.Adenosine testing after secondgeneration cryoballoon ablation(ATSCA)study improves clinical success rate for atrial fibrillation.Europace,2015,17(6):871-876.
• [13]Macle L,Khairy P,Weerasooriya R,et al.Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation:an international,multicentre,randomised superiority trial.Lancet,2015,386(9994):672-679.
• [14]Arentz T,Macle L,Kalusche D,et al.“Dormant”pulmonary vein conduction revealed by adenosine after ostial radiofrequency catheter ablation.J Cardiovasc Electrophysiol,2004,15(9):1041-1047.
• [15]Miyazaki S,Kuwahara T,Kobori A,et al.Impact of adenosineprovoked acute dormant pulmonary vein conduction on recurrence of atrial fibrillation.J Cardiovasc Electrophysiol,2012,23(3):256-260.
• [16]McLellan AJ,Kumar S,Smith C,et al.The role of adenosine challenge in catheter ablation for atrial fibrillation:a systematic review and meta-analysis.Int J Cardiol,2017,236:253-261.
• [17]Kobori A,Shizuta S,Inoue K,et al.Adenosine triphosphate-guided pulmonary vein isolation for atrial fibrillation:the UNmasking dormant electrical reconduction by adenosine TriPhosphate(UNDER-ATP)trial.Eur.Heart J,2015,36(46):3276-3287.
• [18]Ehrlich JR,Cha TJ,Zhang L,et al.Characterization of a hyperpolarization-activated time-dependent potassium current in canine cardiomyocytes from pulmonary vein myocardial sleeves and left atrium.J Physiol,2004,557(Pt2):583-597.
• [19]Cherry EM,Ehrlich JR,Nattel S,et al.Pulmonary vein reentryproperties and size matter:insights from a computational analysis.Heart Rhythm,2007,4(12):1553-1562.
• [20]Ehrlich JR,Cha TJ,Zhang L,et al.Cellular electrophysiology of canine pulmonary vein cardiomyocytes:action potential and ionic current properties.J Physiol,2003,551(Pt 3):801-813.
• [21]Li GR,Feng J,Shrier A,et al.Contribution of ATP-sensitive potas-sium channels to the electrophysiological effects of adenosine in guinea-pig atrial cells.J Physiol,1995,484(pt 3):629-642.
• [22]Tokuda M,Matsuo S,Isogai R,et al.Adenosine testing during cryoballoon ablation and radiof requency ablation of atrial fibrillation:a propensity score-matched analysis.Heart Rhythm,2016,13(11):2128-2134.
• [23]Ciconte G,Chierchia GB,DE Asmundis C,et al.Spontaneous and adenosine-induced pulmonary vein reconnection af ter cryoballoon ablation with the second-generation device.J Cardiovasc Electrophysiol,2014,25(8):845-851.
• [24]Yamane T1,Matsuo S,Date T,et al.Repeated provocation of time-and ATP-induced early pulmonary vein reconnections after pulmonary vein isolation:eliminating paroxysmal atrial fibrillation in a single procedure.Circ Arrhythm Electrophysiol,2011,4(5):601-608.
• [25]田颖,刘兴鹏,尹先东,等.心房颤动肺静脉电隔离术后三磷酸腺苷激发试验的相关因素分析.中华心律失常学杂志,2013,17(3):180-183.
• [26]Cheung JW,Chung JH,Ip JE,et al.Time course of adenosineinduced pulmonary vein reconnection after isolation:implications for mechanism of dormant conduction.Pacing Clin Electrophysiol,2012,35(5):556-563.
• [27]Macle L,Khairy P,Verma A,et al.Adenosine following pulmonary vein isolation to target dormant conduction elimination(ADVICE):methods and rationale.Can J Cardiol,2012,28(2):184-190.
• [28]Gula LJ1,Massel D,Leong-Sit P,et al.Does adenosine response predict clinical recurrence of atrial fibrillation after pulmonary vein isolation?J Cardiovasc Electrophysiol,2011,22(9):982-986.
• [29]Ghanbari H,Jani R,Hussain-Amin A,et al.Role of adenosine af ter antral pulmonary vein isolation of paroxysmal atrial fibrillation:a randomized controlled trial.Heart Rhythm,2016,13(2):407-415.
• [30]夏云兵,黄卫斌.ATP对阵发性心房颤动环肺静脉电隔离术后疗效判断的价值.心脑血管病防治杂志,2014,14(2):108-110.
• [31]Papageorgiou N,Providência R,Srinivasan N,et al.Adenosineguided pulmonary vein isolation versus conventional pulmonary vein isolation in patients undergoing atrial fibrillation ablation:an updated meta-analysis.Int J Cardiol,2017,227:151-160.
• [32]Nery PB,Belliveau D,Nair GM,et al.Relationship between pulmonary vein reconnection and atrial fibrillation recurrence:a systema t ic r eview a nd meta-a nal ysis.J ACC Cli nical Electrophysiology,2016,2(4):474-483.