Piorkowski Christopher, Kottkamp Hans, Tanner Hildegard, Kobza Richard, Nielsen Jens Cosedis, Arya Arash, Hindricks Gerhard
University of Leipzig, Heart Center, Department of Electrophysiology Strümpellstrasse, Leipzig, Germany.
J Cardiovasc Electrophysiol. 2005 Dec;16(12):1286-92. doi: 10.1111/j.1540-8167.2005.00245.x.
The objective of this study was to compare transtelephonic ECG every 2 days and serial 7-day Holter as two methods of follow-up after atrial fibrillation (AF) catheter ablation for the judgment of ablation success. Patients with highly symptomatic AF are increasingly treated with catheter ablation. Several methods of follow-up have been described, and judgment on ablation success often relies on patients' symptoms. However, the optimal follow-up strategy objectively detecting most of the AF recurrences is yet unclear.
Thirty patients with highly symptomatic AF were selected for circumferential pulmonary vein ablation. During follow-up, a transtelephonic ECG was transmitted once every 2 days for half a year. Additionally, a 7-day Holter was recorded preablation, after ablation, after 3 and 6 months, respectively. With both, procedures symptoms and actual rhythm were correlated thoroughly.
A total of 2,600 transtelephonic ECGs were collected with 216 of them showing AF. 25% of those episodes were asymptomatic. On a Kaplan-Meier analysis 45% of the patients with paroxysmal AF were still in continuous SR after 6 months. Simulating a follow-up based on symptomatic recurrences only, that number would have increased to 70%. Using serial 7-day ECG, 113 Holter with over 18,900 hours of ECG recording were acquired. After 6 months the percentage of patients classified as free from AF was 50%. Of the patients with recurrences, 30-40% were completely asymptomatic. The percentage of asymptomatic AF episodes stepwise increased from 11% prior ablation to 53% 6 months after.
The success rate in terms of freedom from AF was 70% on a symptom-only-based follow-up; using serial 7-day Holter it decreased to 50% and on transtelephonic monitoring to 45%, respectively. Transtelephonic ECG and serial 7-day Holter were equally effective to objectively determine long-term success and to detect asymptomatic patients.
本研究的目的是比较每2天进行一次的电话心电图检查和连续7天的动态心电图监测这两种房颤（AF）导管消融术后随访方法，以判断消融是否成功。症状严重的房颤患者越来越多地接受导管消融治疗。已经描述了几种随访方法，而对消融成功与否的判断通常依赖于患者的症状。然而，能客观检测到大多数房颤复发的最佳随访策略仍不明确。
选择30例症状严重的房颤患者进行环肺静脉消融。随访期间，每2天传输一次电话心电图，持续半年。此外，分别在消融术前、消融术后、术后3个月和6个月记录7天动态心电图。将两种检查方法与症状和实际心律进行全面关联。
共收集到2600份电话心电图，其中216份显示房颤。这些发作中有25%是无症状的。根据Kaplan-Meier分析，6个月后45%的阵发性房颤患者仍维持持续性窦性心律（SR）。仅基于症状复发模拟随访，这一数字将增至70%。使用连续7天心电图，共获得113份动态心电图，记录时长超过18900小时。6个月后，被判定无房颤的患者比例为50%。在复发的患者中，30%-40%完全无症状。无症状房颤发作的比例从消融术前的11%逐步增至术后6个月的53%。
仅基于症状的随访中，无房颤的成功率为70%；使用连续7天动态心电图监测时降至50%，电话心电图监测时降至45%。电话心电图和连续7天动态心电图在客观判定长期成功率及检测无症状患者方面同样有效。
Zotero 插件