Long-Term Clinical Results of 2 Different Ablation Strategies in Patients With Paroxysmal and Persistent Atrial Fibrillation
Long-Term Clinical Results of 2 Different Ablation Strategies in Patients With Paroxysmal and Persistent Atrial Fibrillation
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DOI：
10.1161/circep.108.774885
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发表时间：
2008-10-01
影响因子：
8.4
通讯作者：
Giustetto, Carla
中科院分区：
文献类型：
--
作者：
Gaita, Fiorenzo;Caponi, Domenico;Giustetto, Carla
背景：关于房颤（AF）消融的长期疗效的数据仍然缺乏。方法和结果：244例连续出现阵发性或持续性/永久性房颤症状的患者被随机分配到2种不同的消融方案：肺静脉隔离（PVI）和PVI加左线性病变（LL）。主要目的是评估在至少3年的长期随访中，在没有抗心律失常药物的情况下，手术1和手术2后窦性心律（SR）的维持情况。阵发性房颤——在12个月的随访中，46%的PVI患者维持SR，而在3年的随访中，29%的患者维持SR；在12个月的随访中，57%的患者处于SR状态，而在3年的随访中，53%的患者仍处于SR状态。在第二次手术后，无抗心律失常药物的长期总体成功率为62%，PVI + LL组为85%。持续性/永久性af -在12个月的随访中，27%的PVI患者处于SR，而在3年随访中，19%的患者维持SR；在12个月的随访中，45%的患者处于SR状态，而在3年的随访中，41%的患者仍处于SR状态。在第二次手术后，无抗心律失常药物的PVI患者的长期总体成功率为39%，PVI + LL患者为75%。结论：房颤消融的长期随访显示，短期结果不能被认为是永久性的，因为房颤在一年后仍然存在复发，特别是在采用“PVI”策略的患者中。在不使用抗心律失常药物的情况下，PVI隔离加LL优于PVI策略（中国心律失常电生理杂志，2008;1:269-275）。
Background-Data regarding the long-term efficacy of atrial fibrillation (AF) ablation are still lackingMethods and Results-Two hundred four consecutive patients symptomatic for paroxysmal or persistent/permanent AF were randomly assigned to 2 different ablation schemes: Pulmonary vein isolation (PVI) and PVI plus left linear lesions (LL). Primary end point was to assess the maintenance of sinus rhythm (SR) after procedures 1 and 2 in the absence of antiarrhythmic drugs in a long-term follow-up of at least 3 years.Paroxysmal AF-With a single procedure at 12-month follow-up, 46% of patients treated with PVI maintained SR, whereas at 3-year follow-up, 29% were in SR; using the plus LL" at the 12-month follow-up, 57% of patients were in SR, whereas at the 3-year follow-up, 53% remained in SR. After a second procedure, the long-term overall success rate without antiarrhythmic drugs was 62% with PVI and 85% with PVI plus LL.Persistent/Permanent AF-With a single procedure at the 12-month follow-up, 27% of patients treated with PVI were in SR, whereas at the 3-year follow-up, 19% maintained SR; using the PVI plus LL with a single procedure at the 12-month follow-up 45% of patients were in SR, whereas at the 3-year follow-up, 41% remained in SR. After a second procedure, the long-term overall success rate without antiarrhythmic drugs was 39% with PVI and 75% with PVI plus LL.Conclusions-A long-term follow-up of AF ablation shows that short-term results cannot be considered permanent because AF recurrences are still present after the first year especially in patients who have had "PVI" strategy. PVI isolation plus LL is superior to the PVI strategy in maintaining SR without antiarrhythmic drugs after procedures 1 and 2 both in and persistent AF. (Circ Arrhythmia Electrophysiol. 2008;1:269-275.)