Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation
Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation
复制标题
DOI：
10.1093/eurheartj/ehm027
复制
发表时间：
2007-04-01
影响因子：
39.3
通讯作者：
Brugada, Josep
中科院分区：
文献类型：
--
作者：
Berruezo, Antonio;Tamborero, David;Brugada, Josep
目的探讨环状肺静脉消融术(CPVA)治疗心房颤动的成功率。房颤(AF)的范围从60%到90%，具体取决于不同的系列。该研究的目的是确定标准化CPVA手术后房颤复发的预测因素。方法和结果连续接受CPVA治疗的148例患者中，有症状的阵发性(60.8%)、持续性(23.6%)或永久性(15.5%)抗心律失常药物无效的房颤。所有患者均行CPVA术，并沿后壁和二尖瓣峡部建立辅助阻滞线，并完成至少6个月的随访。19.6%的患者存在结构性心脏病，33.8%的患者存在高血压。随访13.1+/-8.4个月，73.6%的患者房颤无复发，平均1.18+/-0.45次/例(85.2%为1次，14.8%为2次，2.7%为3次)。单因素分析显示，房颤复发的风险随年龄(HR1.03；95%CI1.00~1.06，P=0.031)、既往高血压史(HR2.7；95%CI1.43~5.07，P=0.002)和房颤是否永久性(HR2.23；95%CI1.08~4.59，P=0.042)增加。此外，左心房前后径较大。术前左前降支内径(HIR1.11；95%CI1.05~1.18，P=0.001)和较大的左心室收缩末期内径(HR1.07；95%CI1.00~1.15，P=0.029)与术后房颤复发有关。COX回归分析显示，高血压(OR=2.8；95%CI1.5~5.4；P=0.002)和左前降支(OR=1.1；95%CI1.0 5~1.19，P<；0.001)是房颤复发的独立预测因素。多变量模型预测CPVA术后房颤复发患者的平均比例与术前左前降支的增加呈线性关系。高血压的存在进一步增加了房颤复发的平均预测比例。结论高血压和LAD是CPVA治疗房颤术后房颤复发的独立的术前预测因素，这些数据有助于房颤消融患者的选择。
Aims The success rate of circumferential pulmonary vein ablation (CPVA) to treat atrial. fibrillation (AF) ranges from 60 to 90%, depending on the series. The objective of the study was to identify predictors of AF recurrence after a standardized CPVA procedure.Methods and results A series of 148 consecutive patients undergoing CPVA for symptomatic paroxysmal (60.8%), persistent (23.6%), or permanent (15.5%) AF refractory to antiarrhythmic drugs were included in the study. CPVA with the creation of supplementary block lines along the posterior wall and mitral isthmus was performed and a minimum of 6 months follow-up completed in all patients. Structural heart disease was present in 19.6% and hypertension in 33.8% of patients. After 13.1 +/- 8.4 months follow-up, 73.6% of patients were free of AF recurrences after a mean of 1.18 +/- 0.45 procedures/patient (one procedure in 85.2%, two procedures in 14.8%, and three procedures in 2.7%). Univariable analysis showed that the risk of AF recurrence increases with age (HR 1.03; 95% CI 1.00-1.06, P = 0.031), with the presence of previous hypertension (HR 2.7; 95% CI 1.43-5.07, P = 0.002), and if AF is permanent (HR 2.23; 95% CI 1.08-4.59, P = 0.042). In addition, larger anteroposterior left atrial. diameter (LAD) (HIR 1.11; 95% CI 1.05-1.18, P = 0.001) and larger left ventricular end-systolic diameter (HR 1.07; 95% CI 1.00-1.15, P = 0.029) prior to the procedure were associated with AF recurrence after CPVA. Cox regression analysis showed that hypertension (OR = 2.8; 95% CI 1.5-5.4; P = 0.002) and LAD (OR = 1.1; 95% CI 1.05-1.19, P < 0.001) were independent predictors of AF recurrence. The mean predicted proportion of patients with AF recurrence after CPVA of the multivariable model showed a linear relationship with the increase in LAD prior to the procedure. The presence of hypertension further increased the mean predicted proportion of patients with AF recurrence at each LAD.Conclusion Hypertension and LAD are independent pre-procedural predictors of AF recurrence after CPVA to treat AF These data may help in patient selection for AF ablation.