Predictors of Recurrence in Patients Undergoing Cryoballoon Ablation for Treatment of Atrial Fibrillation: The Independent Role of Sleep-Disordered Breathing
Predictors of Recurrence in Patients Undergoing Cryoballoon Ablation for Treatment of Atrial Fibrillation: The Independent Role of Sleep-Disordered Breathing
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DOI：
10.1111/j.1540-8167.2011.02148.x
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发表时间：
2012-01-01
影响因子：
2.7
通讯作者：
Oldenburg, Olaf
中科院分区：
文献类型：
--
作者：
Bitter, Thomas;Noelker, Georg;Oldenburg, Olaf
冷冻球囊肺静脉隔离术后房颤复发的预测因素。简介：在接受肺静脉隔离的房颤（AF）患者中，冷冻球囊技术（cryoPVI）已被许多中心采用。本研究旨在评估AF复发的预测因素，包括睡眠呼吸障碍（SDB）的影响。方法和结果：在82例连续分配到SDB的cryoPVI心肺筛查患者中，在干预前进行病史、ECG、超声心动图、标准实验室测量和血气分析评估。在3个月的空白期后，在3、6和之后每6个月进行一次为期7天的霍尔特ECG，以确定AF复发。75例患者（69例阵发性房颤，6例持续性房颤，22例女性，年龄60 ± 9岁）完成了至少6个月的随访。中位随访12个月（四分位距6-18个月），证实这些患者中有69.4%维持窦性心律。逐步向前回归模型显示中度至重度SDB（截止呼吸暂停低通气指数（AHI）>= 15/小时;风险比（HR）2.95，P = 0.04），AF早期复发（HR 8.74，P < 0.001），持续性房颤（HR 7.16，P < 0.001），术前III类抗肿瘤药物治疗（HR 3.63，P = 0.02），而非SDB本身（AHI >= 5/h）作为房颤复发的独立预测因子。中度至重度SDB是一种可治疗的疾病，可独立预测接受冷冻肺静脉隔离的患者的房颤复发。筛查SDB和适当的治疗可能会提高冷冻PVI的长期成功率。（J.E. Vasc Electrophysiol，第23卷，第100页）2012年1月18日至25日）
Predictors of AF Recurrence After Cryoballoon PVI. Introduction: In patients with atrial fibrillation (AF) undergoing pulmonary vein isolation, cryoballoon technique (cryoPVI) has been adopted in many centers. This study aimed to evaluate predictors of AF recurrence including impact of sleep-disordered breathing (SDB).Methods and Results: In 82 patients consecutively assigned to cryoPVI cardiorespiratory screening for SDB, assessment of medical history, ECG, echocardiography, standard laboratory measurement, and blood gas analysis were performed prior to intervention. After a 3-month blanking period, a 7-day Holter ECG was performed at 3, 6 and then every 6 months to determine AF recurrence. Seventy-five patients (69 paroxysmal AF, 6 persistent AF, 22 female, age 60 +/- 9 years) completed at least 6-month follow-up. Median follow-up of 12 months (interquartile range 6-18 months) confirmed maintenance of sinus rhythm in 69.4% of these patients. Stepwise forward regression model revealed moderate to severe SDB (cut-off apnea-hypopnea-index (AHI) >= 15 per hour; Hazard Ratio (HR) 2.95, P = 0.04), early recurrence of AF (HR 8.74, P < 0.001), persistent AF (HR 7.16, P < 0.001), preprocedural class III-antiarrhythmic drug treatment (HR 3.63, P = 0.02), but not SDB per se (AHI >= 5 per hour) as independent predictors for AF recurrence.Conclusion: Moderate to severe SDB is a treatable condition that independently predicts AF recurrence in patients undergoing cryoPVI. Screening for SDB and adequate treatment may improve long-term success of cryoPVI. (J Cardiovasc Electrophysiol, Vol. 23, pp. 18-25, January 2012)