Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Circ Arrhythm Electrophysiol. 2010 Jun;3(3):237-42. doi: 10.1161/CIRCEP.109.923771. Epub 2010 Mar 24.
Pulmonary vein isolation (PVI) is increasingly used for treatment of atrial fibrillation (AF), but few reports exist regarding long-term success. We determined 5-year outcomes of PVI among patients with freedom from AF off antiarrhythmic drugs (AAD) for 1 year after PVI.
Consecutive patients with paroxysmal or persistent AF who underwent PVI at the University of Pennsylvania from 2000 to 2003 and were free from AF 1 year after ablation were included. Proximal isolation of PVs and non-PV triggers of AF was performed. Long-term ablation success, defined as freedom from AF off AAD after a single ablation procedure, was determined. All patients had transtelephonic monitoring at 3 to 6 months and 12 months and at least yearly contact thereafter. One hundred twenty-three patients were free of AF without AAD at 1 year. AF freedom off AAD was 85% at 3 years and 71% at 5 years, with an approximate 7% per year late recurrence rate after the first year. Patients with recurrent AF >or=5 years after index PVI were older, had larger left atrial size, more AF triggers and more likely had persistent AF. In multivariate analysis, persistent AF (odds ratio, 2.8; 95% confidence interval, 1.4 to 5.7, P=0.005) and age (odds ratio, 1.1; 95% confidence interval, 1.0 to 1.1, P=0.036) independently predicted long-term AF recurrence.
Among patients with paroxysmal or persistent AF and AF freedom 1 year after segmental PVI, the majority (71%) remained free of AF for up to 5 years, with an approximate late recurrence rate of 7% per year. Continued vigilance for recurrent AF after PV isolation is warranted, particularly in patients with persistent AF.
肺静脉隔离（PVI）越来越多地用于治疗心房颤动（AF），但关于其长期疗效的报道很少。我们旨在评估 PVI 术后 1 年无抗心律失常药物（AAD）的 AF 患者 5 年的疗效。
连续入选 2000 年至 2003 年在宾夕法尼亚大学行 PVI 的阵发性或持续性 AF 患者，消融术后 1 年无 AF。进行近端肺静脉隔离和 AF 的非肺静脉触发灶消融。单次消融术后无 AAD 的 AF 定义为长期消融成功。所有患者在消融后 3 至 6 个月、12 个月以及之后每年均进行电话随访。123 例患者在 1 年时无 AAD 的 AF 发生率为 85%，3 年时为 71%，第 1 年后每年复发率约为 7%。PVI 后复发 AF>5 年的患者年龄较大，左心房较大，AF 触发灶更多，更有可能持续性 AF。多变量分析显示持续性 AF（优势比，2.8；95%置信区间，1.4 至 5.7，P=0.005）和年龄（优势比，1.1；95%置信区间，1.0 至 1.1，P=0.036）独立预测长期 AF 复发。
在阵发性或持续性 AF 患者中，行节段性 PVI 术后 1 年无 AF 的患者，大多数（71%）在 5 年内无 AF 复发，每年的晚期复发率约为 7%。需要持续警惕 PVI 后 AF 的复发，尤其是持续性 AF 的患者。
