Five-Year Outcome of Catheter Ablation of Persistent Atrial Fibrillation Using Termination of Atrial Fibrillation as a Procedural Endpoint
Five-Year Outcome of Catheter Ablation of Persistent Atrial Fibrillation Using Termination of Atrial Fibrillation as a Procedural Endpoint
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DOI：
10.1161/circep.114.001943
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发表时间：
2015-02-01
影响因子：
8.4
通讯作者：
Jais, Pierre
中科院分区：
文献类型：
--
作者：
Scherr, Daniel;Khairy, Paul;Jais, Pierre
背景-本研究旨在确定使用房颤终止作为手术终点的导管消融术治疗持续性房颤（AF）的5年疗效。方法和结果-150例患者（57 ± 10岁）使用逐步消融方法（肺静脉隔离、电描记图引导和线性消融）进行持续性房颤消融，所需的手术终点为房颤终止。对复发性AF或房性心动过速进行重复消融。120例患者（80%）通过消融终止了AF。单次手术后1年、2年和5年的无心律失常生存率分别为35.3% ± 3.9%、28.0% ± 3.7%和16.8% ± 3.2%。末次手术（平均2.1 ± 1.0次手术）后1年、2年和5年的无心律失常生存率分别为89.7% ± 2.5%、79.8% ± 3.4%和62.9% ± 4.5%。在末次消融术后中位随访58个月（四分位距，43-73）期间，150例患者中有97例（64.7%）在未使用抗心律失常药物的情况下保持窦性心律。另外14例（9.3%）患者在重新开始抗心律失常药物治疗后保持窦性心律，另外15例（10.0%）患者仅复发为阵发性复发。首次手术期间未能终止AF（风险比3.831; 95%置信区间，2.070-7.143; P < 0.001），左心房直径>= 50 mm（风险比2.083; 95%置信区间，1.078-4.016; P = 0.03），连续房颤持续时间≥ 18个月（风险比1.984; 95%可信区间，1.024-3.846; P < 0.04），（危险比1.874; 95%可信区间1.037-3.388; P = 0.04）预测心律失常recurrence.Conclusions-in持续性房颤患者，旨在终止房颤的消融策略与大多数患者在5年随访期内心律失常复发的自由。手术房颤未终止和特定基线因素可预测消融术后的长期结局。
Background-This study aimed to determine 5-year efficacy of catheter ablation for persistent atrial fibrillation (AF) using AF termination as a procedural end point.Methods and Results-One hundred fifty patients (57 +/- 10 years) underwent persistent AF ablation using a stepwise ablation approach (pulmonary vein isolation, electrogram-guided, and linear ablation) with the desired procedural end point being AF termination. Repeat ablation was performed for recurrent AF or atrial tachycardia. AF was terminated by ablation in 120 patients (80%). Arrhythmia-free survival rates after a single procedure were 35.3% +/- 3.9%, 28.0% +/- 3.7%, and 16.8% +/- 3.2% at 1, 2, and 5 years, respectively. Arrhythmia-free survival rates after the last procedure (mean 2.1 +/- 1.0 procedures) were 89.7% +/- 2.5%, 79.8% +/- 3.4%, and 62.9% +/- 4.5%, at 1, 2, and 5 years, respectively. During a median follow-up of 58 (interquartile range, 43-73) months after the last ablation procedure, 97 of 150 (64.7%) patients remained in sinus rhythm without antiarrhythmic drugs. Another 14 (9.3%) patients maintained sinus rhythm after reinitiation of antiarrhythmic drugs, and an additional 15 (10.0%) patients regressed to paroxysmal recurrences only. Failure to terminate AF during the index procedure (hazard ratio 3.831; 95% confidence interval, 2.070-7.143; P < 0.001), left atrial diameter >= 50 mm (hazard ratio 2.083; 95% confidence interval, 1.078-4.016; P = 0.03), continuous AF duration >= 18 months (hazard ratio 1.984; 95% confidence interval, 1.024-3.846; P < 0.04), and structural heart disease (hazard ratio 1.874; 95% confidence interval, 1.037-3.388; P = 0.04) predicted arrhythmia recurrence.Conclusions-In patients with persistent AF, an ablation strategy aiming at AF termination is associated with freedom from arrhythmia recurrence in the majority of patients over a 5-year follow-up period. Procedural AF nontermination and specific baseline factors predict long-term outcome after ablation.