Atrial fibrillation ablation success defined by duration of recurrence on cardiac implantable electronic devices
Atrial fibrillation ablation success defined by duration of recurrence on cardiac implantable electronic devices
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DOI：
10.1111/jce.14781
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发表时间：
2020-10-27
影响因子：
2.7
通讯作者：
Passman, Rod
中科院分区：
文献类型：
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作者：
Lohrmann, Graham;Kaplan, Rachel;Passman, Rod
前言房颤消融治疗已成为一种有效的节律控制方法。这项探索性分析旨在确定不同的复发指标如何影响治疗成功的定义。方法利用2007年1月至2019年6月的电子健康记录数据集，结合美敦力心脏可植入电子设备(CIED)的数据，识别在CIED植入后接受首次房颤消融的患者。通过对成功消融的不同定义，对房颤复发的数据进行分析。结果共分析665例房颤患者，其中阵发性房颤248例(平均年龄66.2+/-9.3岁，男性73.0%)，持续性房颤417例(平均年龄67.3+/-9.0岁，男性73.6%)。在阵发性房颤患者中，1年无复发存活率从28.2%到72.1%(分别为6分钟和23小时阈值)，房颤减少的总中位数百分比为99.6%。在持续性房颤患者中，1年无复发存活率从24.9%到60.0%(分别为6分钟和连续7天23小时阈值)，房颤减少时间的中位数百分比为99.3%。在阵发性和持续性房颤患者中，单一的7天监测策略对于检测超过6min的房颤的敏感性不到50%。结论在接受导管消融的房颤患者的真实数据集中，治疗成功率因最小所需房颤持续时间的不同而有很大差异，并受到复发检测方法的显著影响。
Introduction Ablation for atrial fibrillation (AF) has emerged as an effective method of rhythm control. This exploratory analysis aimed to determine how various measures of recurrence would influence the definition of treatment success.Methods Using an electronic health record data set from January 2007 to June 2019 linked with Medtronic cardiac implantable electronic device (CIED) data, patients who underwent a first AF ablation procedure following CIED implantation were identified. Data were analyzed for recurrence of AF stratified by varying definitions of successful ablation. The performance of various simulated external AF monitoring strategies was assessed.Results A total of 665 patients were analyzed including 248 with paroxysmal AF (mean age: 66.2 +/- 9.3 years, 73.0% male) and 417 patients with persistent AF (mean age: 67.3 +/- 9.0 years, 73.6% male). Among patients with paroxysmal AF, survival free from recurrence at 1 year ranged from 28.2% to 72.1% (>6 min and >23 h thresholds, respectively) with an overall median percentage of time in AF reduction of 99.6%. Among patients with persistent AF, survival free from recurrence at 1 year ranged from 24.9% to 60.0% (>6 min and 7 consecutive days > 23 h thresholds, respectively) with an overall median percentage of time in AF reduction of 99.3%. A single 7-day monitoring strategy had a sensitivity of less than 50% for detecting AF greater than 6 min in patients with paroxysmal and persistent AF.Conclusion In this real-world data set of AF patients with CIEDs undergoing catheter ablation, treatment success varied substantially with different definitions of minimally required AF duration and is significantly impacted by the method of recurrence detection.