Importance of non-pulmonary vein triggers ablation to achieve long-term freedom from paroxysmal atrial fibrillation in patients with low ejection fraction
Importance of non-pulmonary vein triggers ablation to achieve long-term freedom from paroxysmal atrial fibrillation in patients with low ejection fraction
复制标题
DOI：
10.1016/j.hrthm.2015.08.029
复制
发表时间：
2016-01-01
期刊：
影响因子：
5.5
通讯作者：
Natale, Andrea
中科院分区：
文献类型：
--
作者：
Zhao, Yonghui;Di Biase, Luigi;Natale, Andrea
背景：对于阵发性心房颤动（PAF）伴左心室收缩功能障碍的患者，肺静脉窦隔离（PVAI）后消融非肺静脉（PV）触发物是否能改善长期手术结果尚不清楚。方法前瞻性研究抗肿瘤药物治疗无效的阵发性房颤患者。患者分为2组：左心室射血分数（LVEF）≥ 50%的患者（II组; n = 545）。根据是否对非肺静脉触发因素进行额外消融（IA组; n = 88）或未进行额外消融（IB组; n = 87），对I组患者进行进一步分组。结果I组患者的非肺静脉触发因素比II组患者多（69.1%vs26.6%，P <0.001）。在15.8 +/- 4.7个月的随访中，I组中保持无复发的患者少于II组（53.7% vs 81.7%; P <0.001）。IA组的长期消融成功率高于IB组（75.0% vs 32.2%; P <0.001），与II组相似（75.0% vs 81.7%; P = 0.44）。在多变量分析中，LVEF
BACKGROUND Whether ablation of non pulmonary vein (PV) triggers after pulmonary vein antrum isolation (PVAI) improves the long-term procedure outcome in patients with paroxysmal atrial fibrillation (PAF) and left ventricular systolic dysfunction is unknown.OBJECTIVE We sought to evaluate whether a more extensive ablation procedure improves outcomes at follow-up.METHODS Consecutive patients with PAF refractory to antiarrhythmic drugs presenting for PVAI were prospectively studied. Patients were categorized into 2 groups: patients with left ventricular ejection fraction (LVEF) = 50% (group II; n = 545). Patients in group I were further divided according to whether additional ablation of non-PV triggers was performed (group IA; n = 88) or not (group IB; n = 87). Long-term ablation success off antiarrhythmic drugs after a single procedure was analyzed.RESULTS Patients in group I had more non-PV triggers than did patients in group II (69.1% vs 26.6%; P < .001). During a follow-up of 15.8 +/- 4.7 months, fewer patients in group I remained free from recurrences than those in group II (53.7% vs 81.7%; P < .001). Long-term ablation success was higher in group IA than in group IB (75.0% vs 32.2%; P < .001) and similar to that in group II (75.0% vs 81.7%; P = .44). In multivariate analysis, LVEF