Shah Arti N, Mittal Suneet, Sichrovsky Tina C, Cotiga Delia, Arshad Aysha, Maleki Kataneh, Pierce Walter J, Steinberg Jonathan S
Al-Sabah Arrhythmia Institute and Division of Cardiology, The St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, New York 10025, USA.
J Cardiovasc Electrophysiol. 2008 Jul;19(7):661-7. doi: 10.1111/j.1540-8167.2008.01101.x. Epub 2008 Feb 13.
Despite encouraging results of pulmonary vein isolation (PVI) ablation for atrial fibrillation (AF), it is unclear whether there is genuine cure or there is an important attrition rate. We sought to determine the long-term outcome of the initial responders who experienced a prolonged AF-free complete response.
From a series of 350 consecutive patients who underwent PVI for AF, 264 patients (75%) (males 71%, age 57 +/- 12 years, paroxysmal AF 87%) who demonstrated >or=1 year AF-free follow-up on no antiarrhythmic drugs were followed for 1-5 years.
During 28 +/- 12 months follow-up, 23 of 264 (8.7%) patients had recurrence of AF. The actuarial recurrence at 2 years postablation was 5.8% and increased to 25.5% at 5 years. Compared with long-term responders, more patients with late recurrence had hypertension (HR = 2.18, P = 0.009) and hyperlipidemia (HR = 4.01, P = 0.0005). Among 18 patients with recurrent AF necessitating repeat PVI, 15 (83%) required re-isolation of > 1 PV and 28 of 45 (58%) PVs showed reconnection. All PVs were re-isolated and five (28%) patients had additional linear ablation. All 15 patients became AF-free again.
Although most patients following PVI remain AF-free, some patients develop "late" recurrence of AF. The "late" recurrence patients are more likely to have hypertension and hyperlipidemia. Most late recurrences are associated with PV reconnections. Our observations emphasize the importance of continued long-term vigilance for AF recurrence, and also raise concerns regarding the need for long-term anticoagulation therapy.
尽管肺静脉隔离（PVI）消融治疗心房颤动（AF）取得了令人鼓舞的结果，但尚不清楚是否能真正治愈，还是存在重要的复发率。我们试图确定经历长期无房颤完全缓解的初始反应者的长期结局。
在一系列连续350例行PVI治疗AF的患者中，264例（75%）（男性71%，年龄57±12岁，阵发性AF 87%）在未使用抗心律失常药物的情况下无房颤随访≥1年，随访1至5年。
在28±12个月的随访期间，264例患者中有23例（8.7%）发生房颤复发。消融术后2年的累积复发率为5.8%，5年时增至25.5%。与长期反应者相比，晚期复发的患者更多患有高血压（HR = 2.18，P = 0.009）和高脂血症（HR = 4.01，P = 0.0005）。在18例因房颤复发需要重复PVI的患者中，15例（83%）需要重新隔离>1条肺静脉，45条肺静脉中有28条（58%）显示重新连接。所有肺静脉均重新隔离，5例（28%）患者进行了额外的线性消融。所有15例患者再次恢复无房颤状态。
尽管大多数接受PVI治疗的患者仍保持无房颤状态，但一些患者会出现房颤“晚期”复发。“晚期”复发患者更易患高血压和高脂血症。大多数晚期复发与肺静脉重新连接有关。我们的观察结果强调了对房颤复发持续进行长期监测的重要性，同时也引发了对长期抗凝治疗必要性的关注。
