Long Atrial Fibrillation Duration and Early Recurrence Are Reliable Predictors of Late Recurrence After Radiofrequency Catheter Ablation.
Long Atrial Fibrillation Duration and Early Recurrence Are Reliable Predictors of Late Recurrence After Radiofrequency Catheter Ablation.
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DOI：
10.3389/fcvm.2022.864417
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发表时间：
2022
影响因子：
3.6
通讯作者：
Xia Y
中科院分区：
文献类型：
--
作者：
Li Z;Wang S;Hidru TH;Sun Y;Gao L;Yang X;Xia Y
心房颤动（AF）消融术后复发仍然很常见。本研究旨在评价房颤持续时间和早期复发（ER）的预测能力，以区分复发的高风险患者。我们入组了1，763例连续房颤患者，这些患者计划于2016年1月至2021年8月在中国大连接受首次射频导管消融术（RFCA）。如果AF病程持续≥ 12个月，则考虑长AF持续时间（LAFD）。ER定义为RFCA后3个月内发生的任何房性心动过速（AT）或AF事件超过30 s。1,763例患者中有643例（36.5%）在RFCA后中位35个月发生晚期复发。多变量分析确定LAFD（风险比（HR）：1.80，95%置信区间（CI）：1.38-2.35，p < 0.001）和ER（HR：2.34，95% CI：1.82-3.01，p < 0.001）作为非阵发性房颤晚期复发的强独立预测因子。（HR：1.48，95% CI：1.20-1.84，p < 0.001）和ER（HR：3.40，95% CI：2.68-4.30，p < 0.001）与阵发性房颤的晚期复发显著相关。（CAD、心房直径、年龄、持续或长期AF、抗心律失常药物失败、女性）具有最高的预测能力[ROC曲线下面积（AUC）0.586]。将ER和LAFD添加到CAAP-AF评分中显著提高了AF消融术后晚期复发的风险区分度，从0.586提高到0.686。AF持续时间长和ER与晚期复发独立相关。CAAP-AF模型对复发的预测性能通过增加LAFD和ER得到改善。
Recurrence after atrial fibrillation (AF) ablation is still common. This study aimed to evaluate the predictive abilities of AF duration and early recurrence (ER) to discriminate high-risk patients for recurrence. We enrolled 1,763 consecutive patients with AF who were scheduled to receive the index radiofrequency catheter ablation (RFCA) from January 2016 to August 2021 in Dalian, China. Long AF duration (LAFD) was considered if the course of AF lasted for ≥ 12 months. ER was defined as any atrial tachycardia (AT) or AF event longer than 30 s occurring within a 3-month post-RFCA. Late recurrence occurred in 643 (36.5%) of the 1,763 patients at a median of 35 months after RFCA. Multivariate analysis identified LAFD (hazard ratio (HR): 1.80, 95% confidence interval (CI): 1.38–2.35, p < 0.001) and ER (HR: 2.34, 95% CI: 1.82–3.01, p < 0.001) as strong independent predictors of late recurrence in non-paroxysmal AF. Similarly, LAFD (HR: 1.48, 95% CI: 1.20–1.84, p < 0.001) and ER (HR: 3.40, 95% CI: 2.68–4.30, p < 0.001) were significantly associated with late recurrence in paroxysmal AF. Receiver operating curve analyses revealed that the CAAP-AF (CAD, Atrial diameter, Age, Persistent or longstanding AF, Antiarrhythmic drugs failed, Female) had the highest predict power [area under ROC curve (AUC) 0.586]. The addition of ER and LAFD to the CAAP-AF score significantly improved risk discrimination for late recurrence after AF ablation from 0.586 to 0.686. Long AF duration and ER were independently associated with late recurrence. The prediction performance of the CAAP-AF model for recurrence was improved by the addition of LAFD and ER.