The efficacy of combination of transcatheter atrial septal defects closure and radiofrequency catheter ablation for the prevention of atrial fibrillation recurrence through bi-atrial reverse remodeling
The efficacy of combination of transcatheter atrial septal defects closure and radiofrequency catheter ablation for the prevention of atrial fibrillation recurrence through bi-atrial reverse remodeling
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经导管房间隔缺损封堵联合射频消融双心房逆重塑预防房颤复发的疗效
DOI：
10.1007/s10840-019-00656-2
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发表时间：
2020
影响因子：
1.8
通讯作者：
Takeishi Yasuchika
中科院分区：
文献类型：
--
作者：
Kamioka Masashi;Yoshihisa Akiomi;Hijioka Naoko;Nodera Minoru;Yamada Shinya;Kaneshiro Takashi;Oikawa Masayoshi;Kobayashi Atsushi;Kunii Hiroyuki;Takeishi Yasuchika
目的心房颤动（AF）常与房间隔缺损（ASD）并存。ASD的经导管封堵术和AF的射频消融术（RFCA）均已被确立为一线治疗方法。然而，关于RFCA联合经导管ASD封堵术治疗AF伴ASD患者AF复发的疗效数据有限。本研究的目的是调查射频消融术后房间隔缺损封堵对房颤复发的临床影响。年龄54 ± 20岁，男性17例，分为三组：ASD封堵-窦性心律（ASO-SR）组26例，ASD封堵前无房颤病史，ASO-AF-RFCA组11例，ASD封堵前因房颤病史行RFCA; ASO-AF-AAD（ASO-AF-AAD）治疗组5例，在ASD封堵术前后均给予AAD治疗。结果Kaplan-Meier分析显示，在14 ± 9个月的随访期内，ASO-SR组和ASO-AF-RFCA组的AF发生率低于ASO-AF-AAD组（P= 0.013）。ASO-SR和ASO-AF-RFCA组的AF发生率相当（P= 0.480）。双心房逆向重构，如左心房容积指数降低（P= 0.049）和右心房面积（P= 0.046），高敏C反应蛋白水平显著降低（P= 0.049），ASO-AF-AAD组无明显变化。结论两种经皮治疗方法的联合应用是有效的，心房逆向重构与炎症反应相关。
PurposeAtrial fibrillation (AF) often coexists with atrial septal defects (ASD). Each of the transcatheter closure for ASD and radiofrequency catheter ablation (RFCA) for AF have been established as the first-line therapy. However, there are limited data about therapeutic effect RFCA plus transcatheter ASD closure on AF recurrence in AF patients with ASD. The aim of the current study was to investigate the clinical impact of ASD closure following RFCA on AF recurrence.MethodsForty-two ASD patients (17 males and 54 ± 20 years old) were enrolled and classified into three groups: ASD occlusion-sinus rhythm (ASO-SR) (n= 26), no AF history prior to ASD closure; ASO-AF-RFCA (n= 11), RFCA was performed due to AF history before ASD closure; and ASO-AF-anti-arrhythmic drug (ASO-AF-AAD) (n= 5), AF was treated with AAD before and after ASD closure. AF occurrence among the 3 groups was evaluated.ResultsKaplan-Meier analysis showed that ASO-SR and ASO-AF-RFCA groups showed a lower AF occurrence ratio than ASO-AF-AAD group during the 14- ± 9-month follow-up periods (P= 0.013). AF occurrence in ASO-SR and ASO-AF-RFCA groups was comparable (P= 0.480). Bi-atrial reverse remodeling, such as decrease in left atrial volume index (P= 0.049) and right atrial area (P= 0.046), and significant decrease in high-sensitivity C-reactive protein levels (P= 0.049) were identified in ASO-AF-RFCA group, but not in ASO-AF-AAD group.ConclusionA combination of two percutaneous therapies was proven to be effective and induced bi-atrial reverse remodeling in association with inflammatory reaction.
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