Five-year outcomes after segmental pulmonary vein isolation for paroxysmal atrial fibrillation.
Five-year outcomes after segmental pulmonary vein isolation for paroxysmal atrial fibrillation.
复制标题
DOI：
10.1016/j.amjcard.2009.03.044
复制
发表时间：
2009-08-01
影响因子：
2.8
通讯作者：
Feld, Gregory K.
中科院分区：
文献类型：
--
作者：
Sawhney, Navinder;Anousheh, Ramtin;Chen, Wei-Chung;Narayan, Sanjiv;Feld, Gregory K.
大多数评估房颤消融效果的试验报告了1-2年的随访期。节段性肺静脉隔离术(PVI)治疗阵发性房颤(PAF)后的长期结果(>；5年)大多未见报道。目的评价节段性PVI治疗难治性阵发性房颤的远期疗效。对在加州大学圣地亚哥分校医学中心接受肺静脉隔离术的阵发性房颤患者进行了回顾性评估，以确定指标性手术的结果。在2002年1月1日至2003年8月31日期间在加州大学圣迭戈分校医学中心进行的118例节段性肺静脉隔离手术中，有长期随访资料的71例患者纳入其中。五年的结果是根据指数程序后五年或五年后的最后一次临床会诊和电话会诊来确定的。患者进行常规的EKG临床检查，并接受心脏监测，以确定是否有复发心律失常的症状。71例患者(60±10岁，男56例)随访5年。一次手术后，随访12个月，61例(86%)患者无症状性房颤(AF)。24个月后，56名患者(79%)仍无房颤。随访63±5个月，一次消融后仅40例(56%)患者无症状性房颤。16例患者(22.5%)在消融后第二年复发，其中4例在消融后3年复发，4例在消融后4年复发，8例在消融后首次复发超过48个月。31例患者接受了一次以上的消融手术，平均每例患者1.9±0.9次。经多次治疗后，60例(84%)患者在首次治疗后63个月±5个月停药。在多次消融的患者中，最后一次消融后的平均随访时间为7.5±2.1个月。节段性消融治疗阵发性房颤的整体五年结果与先前报道的较短期随访(≤2年)是一致的；然而，成功的初始消融程序后晚期复发(>；2年)并不少见，而且经常需要重复消融程序以保持无症状性心律失常。在初步消融成功后，对PAF患者进行持续的长期随访可能是有必要的，特别是在那些停止抗凝的患者。
Most trials evaluating the efficacy of atrial fibrillation ablation report follow-up periods of 1–2 years. Long term results (> 5 years) following segmental pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) are largely unreported. To evaluate the long-term efficacy of segmental PVI for the treatment of symptomatic, medically refractory, PAF. Patients with paroxysmal atrial fibrillation who underwent pulmonary vein isolation at the University of California, San Diego Medical Center were evaluated retrospectively to determine the outcome of the index procedure. Of one hundred and eighteen segmental pulmonary vein isolation procedures preformed at UCSD Medical Center between January 1, 2002 and August 31, 2003, seventy-one patients who had long-term follow-up data were included. The five year outcomes were determined by last clinic encounter and telephone encounter at or after five years from the index procedure. Patients had routine clinic visits with EKGs and underwent cardiac monitoring for any complaints of symptoms suggestive of recurrent arrhythmia. Seventy-one patients (60±10 years, 56 male) were followed for > 5 years. After one procedure, with 12 months of follow up, sixty-one (86%) of patients were free from symptomatic atrial fibrillation (AF). After 24 months, fifty-six (79%) of patients remained free of AF. At the end of a follow up period of 63±5 months, only forty patients (56%) remained free from symptomatic atrial fibrillation after one procedure. In sixteen patients (22.5%), atrial fibrillation recurred after the second year post-ablation, with four patients recurring during the third year, four patients during the fourth year, and eight patients having their first recurrence of atrial fibrillation greater than 48 months after their index ablation procedure. Thirty-one patients underwent more than one ablation procedure (average 1.9±0.9 procedures per patient). After multiple procedures, sixty patients (84%) were arrhythmia free off medication at 63±5 months after their initial procedure. In patients who underwent more than one ablation procedure, the mean duration of follow up after the last ablation procedure was 7.5±2.1 months. Overall five-year outcomes after segmental PVI for PAF are consistent with previously reported shorter term follow-up (≤ 2 years); however, late recurrences (>2 years) after a successful initial ablation procedure are not infrequent, and repeat ablation procedures are often required to maintain freedom from symptomatic arrhythmias. Continued long-term follow-up of patients with PAF after initially successful ablation may be warranted, especially in those patients in whom anticoagulation is discontinued.
登录
查看更多内容
影响因子：
37.8
作者：
Nanthakumar, K;Plumb, VJ;Kay, GN
通讯作者：
Kay, GN
影响因子：
4.8
作者：
Saksena, Sanjeev;Hettrick, Douglas A.;Padeletti, Luigi
通讯作者：
Padeletti, Luigi
影响因子：
37.8
作者：
Haïssaguerre, M;Shah, DC;Clémenty, J
通讯作者：
Clémenty, J
影响因子：
37.8
作者：
Oral, H;Scharf, C;Morady, F
通讯作者：
Morady, F
影响因子：
24
作者：
Lemola, K;Oral, H;Morady, F
通讯作者：
Morady, F