Gianfranchi L, Brignole M, Menozzi C, Lolli G, Bottoni N
Arrhythmologic Center, Ospedali Riuniti, Lavagna, Italy.
Europace. 1999 Jan;1(1):35-9. doi: 10.1053/eupc.1998.0008.
We evaluated the rate of progression of permanent atrial fibrillation (AF) and identified clinical factors that predict this event in 63 consecutive patients who had undergone AV junctional ablation and DDDR pacemaker implantation for drug-refractory paroxysmal atrial fibrillation/ flutter. Immediately after ablation, anti-arrhythmic drugs were discontinued in all cases. Permanent AF was considered to have developed if AF was present on two consecutive 6-monthly examinations with no interim documented sinus rhythm. During a mean follow-up of 23 +/- 16 months, 22 (35%) of the 63 patients developed permanent AF. The actuarial estimate of progression of permanent AF was 22%, 40% and 56%, respectively, 1, 2 and 3 years after ablation. Age and underlying heart disease were independent predictors of progression of permanent AF. Only one (6%) of 16 patients with idiopathic AF had permanent AF (low risk group). Among the 47 patients with structural heart disease, permanent AF developed in 18 (62%) of the 29 who were aged >75 years or had >12 arrhythmic episodes per year and a symptom duration >4 years (high risk group), but only in three (17%) of the remaining 18 patients who did not (intermediate risk group). In conclusion, during a 3-year follow-up period, about half of the patients with a history of drug-refractory paroxysmal AF did not develop permanent AF after AV junctional ablation and dual-chamber pacemaker implantation, even in the absence of anti-arrhythmic drug therapy. Moreover, subgroups of patients whose risk of permanent AF progression differed were identified on the basis of simple baseline clinical variables. The results of this study form the necessary background for the correct management of patients after AV junction ablation and for the planning of future trials in this field.
我们评估了永久性心房颤动（AF）的进展率，并在63例因药物难治性阵发性心房颤动/心房扑动而接受房室交界区消融和DDDR起搏器植入的连续患者中，确定了预测该事件的临床因素。消融术后立即停用所有抗心律失常药物。如果在连续两次6个月的检查中均出现AF且无中间记录的窦性心律，则认为发生了永久性AF。在平均23±16个月的随访期间，63例患者中有22例（35%）发生了永久性AF。消融后1年、2年和3年，永久性AF进展的精算估计分别为22%、40%和56%。年龄和基础心脏病是永久性AF进展的独立预测因素。16例特发性AF患者中只有1例（6%）发生了永久性AF（低风险组）。在47例有结构性心脏病的患者中，29例年龄>75岁或每年有>12次心律失常发作且症状持续时间>4年的患者中有18例（62%）发生了永久性AF（高风险组），但其余18例未出现上述情况的患者中只有3例（17%）发生了永久性AF（中风险组）。总之，在3年的随访期内，约一半有药物难治性阵发性AF病史的患者在房室交界区消融和双腔起搏器植入后未发生永久性AF，即使未进行抗心律失常药物治疗。此外，根据简单的基线临床变量确定了永久性AF进展风险不同的患者亚组。本研究结果为房室交界区消融术后患者的正确管理以及该领域未来试验的规划提供了必要的背景。
