Cheema Aamir, Dong Jun, Dalal Darshan, Marine Joseph E, Henrikson Charles A, Spragg David, Cheng Alan, Nazarian Saman, Bilchick Kenneth C, Almasry Ibrahim, Sinha Sunil, Scherr Daniel, Halperin Henry, Berger Ronald, Calkins Hugh
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Cardiol. 2007 May 15;99(10):1425-8. doi: 10.1016/j.amjcard.2006.12.073. Epub 2007 Apr 5.
Each of the main approaches to catheter ablation of atrial fibrillation (AF, segmental and circumferential) is associated with limited efficacy in patients with permanent AF. The objective is to report outcomes of circumferential ablation with pulmonary vein (PV) isolation, determined using a circular mapping catheter, in patients with permanent AF and determine relations between the duration of permanent AF and efficacy. The patient population was composed of 41 consecutive patients (34 men; age 58 +/- 11 years) with permanent AF who underwent radiofrequency catheter ablation through circumferential ablation with PV isolation. They were in permanent AF for 2.3 +/- 3.6 years, and 3.4 +/- 2.2 cardioversion procedures and 1.9 +/- 0.8 class I/III antiarrhythmic drugs had failed. After a follow-up of 11 +/- 2 months, the single-procedure success rate was 36% (n = 15) with an additional 12% (n = 5) showing improvement. With repeat procedures in 19%, the success rate was 54% (n = 22) with an additional 12% (n = 5) showing improvement. All patients who underwent repeat ablations had recovered PV conduction. Single-procedure success was higher in patients who were in permanent AF for < or =1 year compared with those in permanent AF for >1 year (50% vs 20%, respectively, p = 0.05). A major complication occurred in 4 patients (8%), including 3 patients with vascular complications and 1 with stroke. In conclusion, study results suggest that circumferential ablation with PV isolation has moderate efficacy in patients with permanent AF. Efficacy is limited in those in continuous AF for >12 months.
房颤导管消融的每种主要方法（节段性和环周性）对于永久性房颤患者的疗效都有限。目的是报告使用环形标测导管进行肺静脉隔离的环周消融在永久性房颤患者中的结果，并确定永久性房颤持续时间与疗效之间的关系。患者群体由41例连续的永久性房颤患者组成（34例男性；年龄58±11岁），他们接受了通过肺静脉隔离的环周消融进行的射频导管消融。他们处于永久性房颤状态2.3±3.6年，3.4±2.2次复律治疗和1.9±0.8种I/III类抗心律失常药物治疗均失败。随访11±2个月后，单次手术成功率为36%（n = 15），另有12%（n = 5）有改善。19%的患者进行了重复手术，成功率为54%（n = 22），另有12%（n = 5）有改善。所有接受重复消融的患者均恢复了肺静脉传导。永久性房颤持续时间≤1年的患者单次手术成功率高于永久性房颤持续时间＞1年的患者（分别为50%和20%，p = 0.05）。4例患者（8%）发生了主要并发症，包括3例血管并发症患者和1例中风患者。总之，研究结果表明，肺静脉隔离的环周消融对永久性房颤患者有中等疗效。对于持续房颤超过12个月的患者，疗效有限。
