Sonne Kai, Patel Dimpi, Mohanty Prasant, Armaganijan Luciana, Riedlbauchova Lucie, El-Ali Moataz, Di Biase Luigi, Venkatraman Preeti, Shaheen Mazen, Kozeluhova Marketa, Schweikert Robert, Burkhardt J David, Canby Robert, Wazni Oussama, Saliba Walid, Natale Andrea
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
J Interv Card Electrophysiol. 2009 Nov;26(2):121-6. doi: 10.1007/s10840-009-9436-1.
To report survival rates in patients treated with pulmonary vein antrum isolation (PVAI), atrioventricular junctional ablation (AVJA), and antiarrhythmic and direct current cardioversion (A+DCCV) at 7 years follow-up.
From February 2002-December 2004, 1,000 consecutive patients underwent PVAI or A+DCCV or AVJA. These patients were matched in a nested casecontrolled methodology. Survival rates were compared at the end of 7 years.
Three hundred and forty-five consecutive patients had undergone PVAI (34.5%), 157 (15.7%) consecutive patients AVJA, and 498(49.8%) A+DCCV. After matching the patients in a nested case-controlled methodology, 146 (32.3%) patients were in the PVAI group, 205 (59.4%) in the A+DCCV, and 101 (22.3%) in the AVJA. At 69+/-27 months, 63 (13.9%) patients had died in the matched population. Three (2.1%) patients died in the PVAI group, 34 (16.5%) in the A+DCCV group, and 26 (25.7%) in the AVJA group. In multivariable analysis, treatment strategy was a significant predictor of mortality. Compared to patients with PVAI (reference group), those with A+ DCCV (HR 4.9, p=0.011) and AVJA (HR 10.6, p=0.001) procedures had higher mortality risk.
Compared to the other two procedures, patients with PVAI had the best survival rates at the end of 7 years. However, the observational case-control design of this study incurs the potential for confounding due to nonrandomized treatment selection, and creates a major limitation in making valid generalization of the findings.
报告接受肺静脉前庭隔离术（PVAI）、房室交界区消融术（AVJA）以及抗心律失常和直流电复律术（A+DCCV）治疗的患者在7年随访期的生存率。
从2002年2月至2004年12月，1000例连续患者接受了PVAI或A+DCCV或AVJA治疗。这些患者采用巢式病例对照方法进行匹配。在7年末比较生存率。
345例连续患者接受了PVAI（34.5%），157例（15.7%）连续患者接受了AVJA，498例（49.8%）接受了A+DCCV。在采用巢式病例对照方法对患者进行匹配后，PVAI组有146例（32.3%）患者，A+DCCV组有205例（59.4%）患者，AVJA组有101例（22.3%）患者。在69±27个月时，匹配人群中有63例（13.9%）患者死亡。PVAI组有3例（2.1%）患者死亡，A+DCCV组有34例（16.5%）患者死亡，AVJA组有26例（25.7%）患者死亡。在多变量分析中，治疗策略是死亡率的显著预测因素。与接受PVAI的患者（参照组）相比，接受A+DCCV（风险比4.9，p=0.011）和AVJA（风险比10.6，p=0.001）手术的患者有更高的死亡风险。
与其他两种手术相比，接受PVAI的患者在7年末的生存率最佳。然而，本研究的观察性病例对照设计因治疗选择非随机而存在混杂的可能性，并且在对研究结果进行有效推广方面造成了重大限制。
