Pulmonary vein antrum isolation for treatment of atrial fibrillation in patients with valvular heart disease or prior open heart surgery.
Pulmonary vein antrum isolation for treatment of atrial fibrillation in patients with valvular heart disease or prior open heart surgery.
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DOI：
10.1016/j.hrthm.2004.02.007
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发表时间：
2004-05
期刊：
影响因子：
5.5
通讯作者：
Y. Khaykin;N. Marrouche;W. Saliba;R. Schweikert;Dianna Bash;Michael S. Chen;Michelle Williams-Andrews;E. Saad;D. Burkhardt;M. Bhargava;G. Joseph;A. Rossillo;D. Erciyes;David O. Martin;A. Natale
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文献类型：
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作者：
Y. Khaykin;N. Marrouche;W. Saliba;R. Schweikert;Dianna Bash;Michael S. Chen;Michelle Williams-Andrews;E. Saad;D. Burkhardt;M. Bhargava;G. Joseph;A. Rossillo;D. Erciyes;David O. Martin;A. Natale
目的 本研究的目的是评估中度瓣膜性心脏病或心脏直视手术和房颤 (AF) 患者肺静脉窦隔离的安全性和有效性。背景心脏瓣膜病和心脏直视手术通常与 AF 相关，并增加 AF 患者不良事件的风险。方法对 2000 年 12 月至 12 月期间进行肺静脉窦隔离的连续 391 例患者进行研究2002年上映。其中 142 名患者患有临床上显着的瓣膜疾病或既往接受过心脏手术。终点包括房颤复发和肺静脉窦隔离并发症发生率。 结果患有瓣膜性心脏病或既往接受过心脏直视手术的患者年龄较大，左心房较大，纽约心脏协会分级较高。他们在性别方面没有显着差异，但有较长的房颤病史。患有和不患有瓣膜性心脏病或既往接受过心脏直视手术的患者的手术时间相似。孤立性 AF 患者 18 ± 7 个月、瓣膜性心脏病患者 11 ± 5 个月、既往接受过心脏直视手术的患者 10 ± 5 个月后，孤立性 AF 患者的 AF 复发率有较低的趋势，在最多 2 次肺静脉窦隔离后，总体治愈率为 98%，而瓣膜性心脏病 (P = .04) 和既往心脏直视手术患者的总体治愈率为 93% (P = .04)。 = .07)。各组间并发症发生率相当。结论肺静脉窦隔离对于中度瓣膜性心脏病患者和心脏直视手术后发生房颤的患者是安全有效的。这些结果对我们理解中度瓣膜性心脏病或既往心脏手术患者的 AF 病理生理学具有重要意义，在讨论这些患者的治疗方案时应予以考虑。
OBJECTIVESThe goal of this study was to assess the safety and efficacy of pulmonary vein antrum isolation in patients with moderate valvular heart disease or open-heart surgery and atrial fibrillation (AF).BACKGROUNDValvular heart disease and open-heart surgery are commonly associated with AF and increase the risk of adverse events in AF patients.METHODSA total of 391 consecutive patients who had pulmonary vein antrum isolation performed between December 2000 and December 2002 were screened. A total of 142 of these patients had clinically significant valvular disease or prior cardiac surgery. End points included AF recurrence and pulmonary vein antrum isolation complication rates.RESULTSPatients with valvular heart disease or prior open-heart surgery were older, had larger left atria and a more advanced New York Heart Association class. They did not differ significantly with respect to gender, but had a longer history of AF. Procedure times were similar between patients with and without valvular heart disease or prior open-heart surgery. After 18 ± 7 months in the lone AF patients, 11 ± 5 months in patients with valvular heart disease, and 10 ± 5 months in patients with prior open heart surgery, there was a trend toward lower recurrence of AF in patients with lone AF who enjoyed a 98% overall cure rate after up to 2 pulmonary vein antrum isolations versus 93% among patients with valvular heart disease (P = .04) and prior open heart surgery (P = .07). Complication rates were comparable between groups.CONCLUSIONSPulmonary vein antrum isolation is safe and effective in patients with moderate valvular heart disease and the patients who developed AF after open-heart surgery. These results have implications for our understanding of the pathophysiology of AF in patients with moderate valvular heart disease or past cardiac surgery and should be considered when discussing treatment options in these patients.