持续时间大于2年的长程持续性房颤复发再次消融的患者:CHA2DS2-VASc 评分和肾小球滤过率对临床预后的影响
持续时间大于2年的长程持续性房颤复发再次消融的患者:CHA2DS2-VASc 评分和肾小球滤过率对临床预后的影响
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作者：
Qian Wang;Shi-Li Jiang;Xu Liu;Yi-Qing Yang
目的长期持续性心房颤动（AF）持续时间超过2年的患者再次导管消融的结果知之甚少。本研究的主要目的是探讨这些重复手术的结果和影响临床成功率的因素。方法将99例房颤持续时间≥ 2年且经导管消融后复发房性心律失常的患者分为房颤复发组（50例）和房性心动过速复发组（49例），并进行严格随访。在基线和再次消融后24个月评估生活质量（QOL）和AF相关症状分类。结果平均随访31个月，30例（30.3%）患者无心律失常复发，房性心动过速复发组的成功率高于房颤复发组（32.7%vs.28.0%，p=0.614）。考克斯回归分析显示了CHA 2DS 2-VASc评分！3是复发的预测因子。肾功能异常的房颤复发患者更容易接受失败的手术。然而，肾功能异常对AT复发患者的重复手术结果没有影响。在24个月随访时，维持窦性心律（SR）的患者的生活质量和AF相关症状显著改善。结论：对于CHA 2DS 2-VASc评分超过2年的长期持续性AF患者，重复手术的成功率很低！3.肾功能受损对AF复发患者的结局有不利影响。对于维持SR的患者，QOL和AF病理学均显著改善。
Objective Little is known about the outcome of repeat catheter ablation of long-standing persistent atrial fibrillation (AF) in patients with a total AF duration of more than 2 years. The main objective of this study was to explore the results and factors affecting the clinical success rate of these repeat procedures..Methods We enrolled 99 patients with a total AF duration of more than 2 years and recurrent atrial arrhyth- mias after the initial catheter ablation of long-standing persistent AF. The enrolled patients were divided into two groups named the AF-recurrence group (50 patients) and the atrial tachycardia (AT)-recurrence group (49 patients) and all underwent a strict follow-up. The quality of life (QOL) and AF-related symptom classifica- tion were assessed at baseline and at 24 months post re-ablation..Results After a mean follow-up of 31 months, 30 (30.3%) patients were free from arrhythmia recurrence, and the success rate in the AT-recurrence group was higher than that in the AF-recurrence group (32.7% vs. 28.0%, p=0.614). A Cox regression analysis revealed a CHA2DS2-VASc score !3 to be a predictor of recur- rence. AF recurrent patients with an abnormal renal function were more prone to undergo a failed procedure. However, an abnormal renal function had no effect on the outcome of the repeat procedure for patients with AT recurrence. At the 24-month follow-up, patients maintaining sinus rhythm (SR) had a significantly im- proved QOL and AF-related symptoms..Conclusion The success rate of repeat procedures for long-standing persistent AF and a total AF duration of more than 2 years is poor for patients with a CHA2DS2-VASc score !3. An impaired renal function has an unfavorable effect on the outcome for patients with AF recurrence. For patients maintaining SR, both the QOL and AF symptomatology improve significantly.