Natural History and Long-Term Outcomes of Ablated Atrial Fibrillation
Natural History and Long-Term Outcomes of Ablated Atrial Fibrillation
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DOI：
10.1161/circep.111.962100
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发表时间：
2011-06-01
影响因子：
8.4
通讯作者：
Wazni, Oussama
中科院分区：
文献类型：
--
作者：
Hussein, Ayman A.;Saliba, Walid I.;Wazni, Oussama
背景-心房颤动（AF）消融术越来越多地应用于临床实践。我们的目的是研究消融AF的自然病史和长期结局。方法和结果-我们在2005年进行肺静脉隔离（PVI）后随访了831例患者。我们使用前瞻性房颤登记研究记录了临床结局，最近一次更新是在2009年10月。在消融术后的第一年，23.8%有早期复发。在长期随访（55个月）中，只有8.9%的患者发生了晚期心律失常复发，定义为消融术后第一年后发生。晚期复发患者的重复消融显示，所有患者中至少有1条先前隔离的肺静脉传导恢复，55.6%的患者在异丙肾上腺素试验中出现右侧触发。末次随访时，临床改善率为89.9%（79.4%的房颤患者停用抗心律失常药物后无房颤，10.5%的房颤患者使用抗心律失常药物后得到控制）。只有4.6%的患者仍有耐药性房颤。在消融术后一年内没有复发（CHADS评分）的患者中，有相当比例的患者可以安全地停止抗凝治疗
Background-Atrial fibrillation (AF) ablation is increasingly used in clinical practice. We aimed to study the natural history and long-term outcomes of ablated AF.Methods and Results-We followed 831 patients after pulmonary vein isolation (PVI) performed in 2005. We documented clinical outcomes using our prospective AF registry with most recent update on this group of patients in October 2009. In the first year after ablation, 23.8% had early recurrence. Over long-term follow-up (55 months), only 8.9% had late arrhythmia recurrence defined as occurring beyond the first year after ablation. Repeat ablations in patients with late recurrence revealed conduction recovery in at least 1 of the previously isolated PVs in all of them and right-sided triggers with isoproterenol testing in 55.6%. At last follow-up, clinical improvement was 89.9% (79.4% arrhythmia-free off antiarrhythmic drugs and 10.5% with AF controlled with antiarrhythmic drugs). Only 4.6% continued to have drug-resistant AF. It was possible to safely discontinue anticoagulation in a substantial proportion of patients with no recurrence in the year after ablation (CHADS score