Proclemer Alessandro, Allocca Giuseppe, Gregori Dario, Bonanno Carlo, Ometto Renato, Fontanelli Alessandro, Mantovan Roberto, Crosato Martino, Calzolari Vittorio, Pavoni Daisy, Facchin Domenico, Rebellato Luca, Fioretti Paolo M
Department of Cardiology, Azienda Ospedaliera-Universitaria and IRCAB Foundation, P.le S. Maria della Misericordia 15, 33100 Udine, Italy.
Europace. 2008 Sep;10(9):1085-90. doi: 10.1093/europace/eun197. Epub 2008 Jul 29.
To compare clinical characteristics, procedure complexity, acute and long-term outcome of 'ablate and pace' (A&P) with pulmonary vein isolation (PVI) in patients with drug-refractory atrial fibrillation (AF). So far, only few small studies have compared the two procedures.
We analysed retrospectively a cohort of symptomatic consecutive patients with drug-refractory AF. Group 1 included 100 patients treated with A&P and Group 2 included 144 patients treated with PVI. Group 1 patients were older (74 +/- 8 vs. 56 +/- 9 years; P < 0.0001), had lower left ventricular ejection fraction (50 +/- 13% vs. 59 +/- 7%; P < 0.05), and a lower prevalence of paroxysmal AF (46% vs. 65%; P < 0.05). Acute success was not statistically different (98% vs. 92.3%, P = ns). Group 1 patients had shorter procedure time and lower radiation exposure with respect to Group 2 patients (70 +/- 15 vs. 204 +/- 58 min, and 8 +/- 4 vs. 57 +/- 22 min; P < 0.0001, respectively). After a median follow-up of 29 months (I, III quartile; 15, 40 months) vs. 25 months (I, III quartile; 8, 36 months) (P = ns), all the patients in Group 1 were free of symptomatic AF, while 113 patients (79%) of Group 2 were in stable sinus rhythm (P < 0.0001). Persistent or permanent AF has been documented in 58 patients (58%) of Group 1 vs. 11 (8%) of Group 2 (P < 0.0001).
In this series (i) patients treated with A&P and PVI for drug-refractory AF showed significant differences in clinical profile; (ii) A&P is a shorter and less complex procedure, but is associated with a higher rate of persistent AF; (iii) symptomatic recurrences of paroxysmal AF were more frequent in PVI group. Randomized studies appear necessary to identify the best strategy in selected cases.
比较“消融与起搏”（A&P）和肺静脉隔离（PVI）治疗药物难治性心房颤动（AF）患者的临床特征、手术复杂性、急性和长期预后。到目前为止，仅有少数小型研究对这两种手术进行了比较。
我们对一组有症状的连续性药物难治性AF患者进行了回顾性分析。第1组包括100例接受A&P治疗的患者，第2组包括144例接受PVI治疗的患者。第1组患者年龄更大（74±8岁 vs. 56±9岁；P<0.0001），左心室射血分数更低（50±13% vs. 59±7%；P<0.05），阵发性AF的患病率更低（46% vs. 65%；P<0.05）。急性成功率无统计学差异（98% vs. 92.3%，P=无显著性差异）。与第2组患者相比，第1组患者的手术时间更短，辐射暴露更低（分别为70±15分钟 vs. 204±58分钟，以及8±4分钟 vs. 57±
22分钟；P<0.0001）。在分别进行了29个月（第一、三分位数；15、40个月）和25个月（第一、三分位数；8、36个月）的中位随访后（P=无显著性差异），第1组所有患者均无有症状的AF，而第2组有113例患者（79%）维持稳定窦性心律（P<0.0001）。第1组有58例患者（58%）记录到持续性或永久性AF，而第2组为11例（8%）（P<0.0001）。
在本系列研究中，（i）接受A&P和PVI治疗的药物难治性AF患者在临床特征上存在显著差异；（ii）A&P是一种更短且复杂性更低的手术，但持续性AF发生率更高；（iii）PVI组阵发性AF的症状性复发更频繁。对于特定病例，似乎有必要进行随机研究以确定最佳策略。
