Richter Bernhard, Gwechenberger Marianne, Socas Ariel, Marx Manfred, Gössinger Heinz David
Department of Cardiology, Medical University of Vienna, Vienna, Austria.
Am J Cardiol. 2008 Mar 15;101(6):843-7. doi: 10.1016/j.amjcard.2007.11.021. Epub 2008 Jan 18.
Because of delayed structural and electrophysiologic effects of radiofrequency ablation of atrial fibrillation (AF), early recurrence of AF after ablation does not necessarily indicate long-term ablation failure. This study was intended to assess the prognostic value of early recurrence of AF within 48 hours after ablation. The study included 234 patients (aged 23 to 80 years; 72% men) with symptomatic drug-resistant paroxysmal (n = 165) or persistent AF (n = 69) who underwent either Lasso-guided segmental pulmonary vein isolation (n = 83) or CARTO-guided left atrial circumferential ablation (n = 151). After a median follow-up of 12.7 months, 64% of patients with paroxysmal and 45% of patients with persistent AF were AF free. Early recurrence of AF occurred in 43% of patients and was more frequently observed in the persistent-AF group (paroxysmal vs persistent 39% vs 54%; p = 0.037). Early recurrence of AF was a significant predictor of long-term ablation failure in univariate (hazard ratio [HR] 2.29, p <0.001) and multivariate (HR 2.17. p <0.001) Cox regression analysis. Nevertheless, 46% of patients with early recurrence of AF were AF free during long-term follow-up compared with 68% of patients without early recurrence of AF. The prognostic value of early recurrence of AF was found in patients with paroxysmal (HR 2.05, p = 0.005) and persistent AF (HR 2.35, p = 0.013). In conclusion, early recurrence of AF within 48 hours after ablation was a significant predictor of a poor long-term ablation outcome. However, because nearly half the patients with early recurrence of AF remained AF free during long-term follow-up, early recurrence of AF should not automatically result in an early repeated procedure.
由于心房颤动（AF）射频消融的结构和电生理效应存在延迟，消融术后AF早期复发并不一定意味着长期消融失败。本研究旨在评估消融后48小时内AF早期复发的预后价值。该研究纳入了234例有症状的药物难治性阵发性（n = 165）或持续性AF（n = 69）患者（年龄23至80岁；72%为男性），这些患者接受了套索引导下的节段性肺静脉隔离术（n = 83）或CARTO引导下的左心房环周消融术（n = 151）。中位随访12.7个月后，64%的阵发性AF患者和45%的持续性AF患者无AF发作。43%的患者出现AF早期复发，且在持续性AF组中更常见（阵发性AF组与持续性AF组分别为39% vs 54%；p = 0.037）。在单因素（风险比[HR] 2.29，p <0.001）和多因素（HR 2.17，p <0.001）Cox回归分析中，AF早期复发是长期消融失败的显著预测因素。然而，在长期随访中，46%的AF早期复发患者无AF发作，而无AF早期复发的患者这一比例为68%。AF早期复发的预后价值在阵发性（HR 2.05，p = 0.005）和持续性AF（HR 2.35，p = 0.013）患者中均有发现。总之，消融后48小时内AF早期复发是长期消融效果不佳的显著预测因素。然而，由于近一半的AF早期复发患者在长期随访中仍无AF发作,AF早期复发不应自动导致早期重复手术。
