心房颤动负荷作为肺静脉隔离术成功预测指标的效用

Usefulness of atrial fibrillation burden as a predictor for success of pulmonary vein isolation.

作者信息

Berkowitsch Alexander, Greiss Harald, Vukajlovic Dejan, Kuniss Malte, Neumann Thomas, Zaltsberg Sergej, Kurzidim Klaus, Hamm Christian, Pitschner Heinz F

机构信息

Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany.

出版信息

Pacing Clin Electrophysiol. 2005 Dec;28(12):1292-301. doi: 10.1111/j.1540-8159.2005.00270.x.

DOI:10.1111/j.1540-8159.2005.00270.x

PMID:16403161

Abstract

BACKGROUND

The definition of symptomatic improvement after pulmonary vein isolation (PVI) is controversial. We assessed primarily the usefulness and predictive accuracy (PA) of AF (atrial fibrillation) burden (AFB) within the first 3 months after the procedure as an early predictor for curative success as well as reduction of symptoms.

METHODS

We studied 100 pts (62 men, mean age: 54 +/- 9 years, LVEF: 57 +/- 9%, paroxysmal AF, 85, persistent AF, 15) who underwent PVI. RF ablation was used in 63 patients. The combination of cryoablation and RF (Hybrid therapy) was used in the remaining 37 patients, in 19 patients of whom additionally linear lesions were performed. All patients were followed up 3 months after PVI (the blanking period) and every 3 months thereafter. The significance of early recurrence of AF (ERAF) was separately analyzed for RF and for hybrid therapy arm. Quality of life (QoL) was assessed using the physical composite summary score (PCS) and mental composite summary score (MCS). AFB was dichotomized at: 0, 0.5, 1, 6, 12, and 24 hours.

RESULTS

ANOVA revealed significant differences between PCS at baseline and after PVI in patients without recurrence and with those with postablation AFB <12 hours. There was no difference between PCS in patients with AFB > or =12 hours within a 3 months interval and PCS at baseline. ERAF occurred in 35% of patients (16 patients, AFB > or =12 hours). Symptomatic ERAF occurred in 29 patients (17 patients AFB > or =12 hours). After the blanking period, documented AF recurrence was found in 50 patients (17 patients, AFB > or =12 hour). Symptomatic late recurrence was found in 47 patients (31 patients with AFB > or =12 hours). Absence of ERAF was revealed to be predictive for long-term success and symptomatic ERAF was found to be predictive for symptomatic AF recurrence (P <0.0001).

CONCLUSION

AF recurrence with AFB > or =12 hours within 3 months is associated with a missed improvement of QoL. Symptomatic ERAF predicts recurrence independently of therapy.

摘要

背景

肺静脉隔离（PVI）术后症状改善的定义存在争议。我们主要评估了术后3个月内房颤（AF）负荷（AFB）作为治愈成功及症状减轻的早期预测指标的有效性和预测准确性（PA）。

方法

我们研究了100例接受PVI的患者（62例男性，平均年龄：54±9岁，左心室射血分数：57±9%，阵发性房颤85例，持续性房颤15例）。63例患者采用射频消融。其余37例患者采用冷冻消融与射频消融联合治疗（混合疗法），其中19例患者还进行了线性消融。所有患者在PVI术后3个月（空白期）及之后每3个月进行随访。分别分析了射频消融组和混合疗法组房颤早期复发（ERAF）的意义。采用躯体综合评分（PCS）和精神综合评分（MCS）评估生活质量（QoL）。AFB在0、0.5、1、6、12和24小时进行二分法划分。

结果

方差分析显示，无复发患者以及消融后AFB<12小时患者的基线PCS与PVI术后PCS之间存在显著差异。AFB≥12小时患者在3个月内的PCS与基线PCS之间无差异。35%的患者发生ERAF（16例患者，AFB≥12小时）。有症状的ERAF发生在29例患者中（17例患者AFB≥12小时）。空白期后，50例患者发现有记录的房颤复发（17例患者，AFB≥12小时）。47例患者发现有症状的晚期复发（31例患者AFB≥12小时）。未发生ERAF被证明可预测长期成功，有症状的ERAF被发现可预测有症状的房颤复发（P<0.0001）。