Della Bella Paolo, Riva Stefania, Fassini Gaetano, Casella Michela, Carbucicchio Corrado, Trevisi Nicola, Berti Marco, Giraldi Francesco, Maccabelli Giuseppe
Arrhythmia Department, Centro Cardiologico Monzino, Institute of Cardiology, University of Milan, Via Parea 4, Milan 20138, Italy.
Europace. 2005 Mar;7(2):95-103. doi: 10.1016/j.eupc.2004.12.008.
This study is a single centre long-term experience on a consecutive cohort of patients with paroxysmal or persistent atrial fibrillation (AF) undergoing electrical disconnection of pulmonary veins (PVs) by means of catheter ablation. Long-term outcome was analyzed in relation to acute procedure success and to the clinical presentation.
Two hundred and thirty-four patients (182 males, mean age 55.9+/-10.6 years), affected by paroxysmal (78%) or persistent AF, underwent an electrophysiologically guided isolation of PVs. ECG, Holter and clinical follow-up were obtained at 1, 3, 6 and 12 months. At discharge an antiarrhythmic drug, Flecainide, was given only in cases with incomplete disconnection; Amiodarone was administered in all persistent AF pts. Successful disconnection of all PVs was achieved in 90% of cases. The rate of stable sinus rhythm maintenance was 85%, 74%, 72% and 65% at 1, 3, 6 and 12 months, respectively. The one-year arrhythmia free survival rates were higher among patients with paroxysmal AF (68% vs. 54%, P 0.008), those with complete disconnection of all PVs and in patients younger than 55 years.
The electrical disconnection of all the pulmonary veins should be the minimal endpoint of radiofrequency catheter ablation in patients with either paroxysmal or persistent AF. Incomplete disconnection of the PVs is predictive of recurrence. Long-term results of the ablation procedure were significantly better in patients with paroxysmal AF.
本研究是一项单中心长期研究，纳入了连续队列中接受肺静脉（PVs）导管消融电隔离术的阵发性或持续性心房颤动（AF）患者。分析长期结局与急性手术成功率及临床表现的关系。
234例患者（182例男性，平均年龄55.9±10.6岁），患有阵发性（78%）或持续性AF，接受了电生理指导下的PVs隔离术。在1、3、6和12个月时进行心电图、动态心电图和临床随访。出院时，仅在隔离不完全的病例中给予抗心律失常药物氟卡尼；所有持续性AF患者均给予胺碘酮。90%的病例成功实现了所有PVs的隔离。在1、3、6和12个月时，窦性心律维持稳定的比例分别为85%、74%、72%和65%。阵发性AF患者、所有PVs完全隔离的患者以及年龄小于55岁的患者，一年无心律失常生存率较高。
对于阵发性或持续性AF患者，所有肺静脉的电隔离应是射频导管消融的最低目标。PVs隔离不完全可预测复发。阵发性AF患者消融手术的长期结果明显更好。
