Fichtner Stephanie, Czudnochowsky Ulrich, Hessling Gabriele, Reents Tilko, Estner Heidi, Wu Jinjin, Jilek Clemens, Ammar Sonia, Karch Martin R, Deisenhofer Isabel
Deutsches Herzzentrum München & 1. Med. Klinik, Technische Universität München, Lazarettstrasse 36, Munich, Germany.
Pacing Clin Electrophysiol. 2010 Oct;33(10):1258-63. doi: 10.1111/j.1540-8159.2010.02808.x.
There are few data about the incidence of very late (>12 months) arrhythmia relapse after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) and about the success rate of repeat ablation procedures in this population.
All patients treated with PVI for paroxysmal AF were screened in the institution's electrophysiology database. Follow-up data at 1, 3, 6, and 12 months and yearly thereafter including repetitive (7 days or 1 day) Holter electrocardiograms were assessed as well as the technique and success rate of repeat ablations.
Overall, 24 of 356 (6.7%) patients experienced their first AF recurrence more than 12 months after PVI. Of these 24 patients, 14 underwent reablation for paroxysmal (11 patients) or persistent AF (three patients). Repeat ablation included re-PVI in all 14 patients (43 of 48 initially isolated PVs with recovered left atrial-PV conduction). Ablation of complex fractionated atrial electrograms or left/right atrial lines was performed in eight patients, including the three patients with persistent AF. During follow-up of 15.1 ± 9 months after the second ablation, 10 of 14 (71%) reablated patients remained in sinus rhythm.
After PVI for paroxysmal AF, very late arrhythmia recurrence occurs in less than 10% of patients. The success rate of the repeat procedure is high.
关于阵发性心房颤动（AF）肺静脉隔离（PVI）术后极晚期（>12个月）心律失常复发的发生率以及该人群再次消融手术成功率的数据较少。
在该机构的电生理数据库中筛选所有接受PVI治疗阵发性AF的患者。评估1、3、6和12个月以及此后每年的随访数据，包括重复性（7天或1天）动态心电图，以及再次消融的技术和成功率。
总体而言，356例患者中有24例（6.7%）在PVI术后12个月以上经历了首次AF复发。在这24例患者中，14例因阵发性（11例）或持续性AF（3例）接受了再次消融。所有14例患者的再次消融均包括再次PVI（48条最初隔离的肺静脉中有43条恢复了左心房-肺静脉传导）。8例患者进行了碎裂心房电图或左/右心房线性消融，包括3例持续性AF患者。在第二次消融后的15.1±9个月随访期间，14例再次消融患者中有10例（71%）维持窦性心律。
阵发性AF行PVI术后，不到10%的患者会出现极晚期心律失常复发。再次手术的成功率很高。
