Department of Cardiology, Royal Melbourne Hospital Department of Medicine, University of Melbourne, Melbourne, Australia.
J Cardiovasc Electrophysiol. 2011 Feb;22(2):137-41. doi: 10.1111/j.1540-8167.2010.01885.x. Epub 2010 Aug 31.
Pulmonary veins play an important role in triggering atrial fibrillation (AF). Pulmonary vein isolation (PVI) is an effective treatment for patients with paroxysmal AF. However, the late AF recurrence rate in long-term follow-up of circumferential PV antral isolation (PVAI) is not well documented. We sought to determine the time to recurrence of arrhythmia after PVAI, and long-term rates of sinus rhythm after circumferential PVAI.
One hundred consecutive patients with a mean age of 54 ± 10 years, with paroxysmal AF who underwent PVAI procedure were analyzed. Isolation of pulmonary veins was based on an electrophysiological and anatomical approach, with a nonfluoroscopic navigation mapping system to guide antral PVI. Ablation endpoint was vein isolation confirmed with a circular mapping catheter at first and subsequent procedures. Clinical, ECG, and Holter follow-up was undertaken every 3 months in the first year postablation, every 6 months thereafter, with additional prolonged monitoring if symptoms were reported. Time to arrhythmia recurrence, and representing arrhythmias, were documented.
Isolation of all 4 veins was successful in 97% patients with 3.9 ± 0.3 veins isolated/patient. Follow-up after the last RF procedure was at a mean of 39 ± 10 months (range 21-66 months). After a single procedure, sinus rhythm was maintained at long-term follow-up in 49% patients without use of antiarrhythmic drugs (AADs). After repeat procedure, sinus rhythm was maintained in 57% patients without the use of AADs, and in 82% patients including patients with AADs. A total of 18 of 100 patients had 2 procedures and 4 of 100 patients had 3 procedures for recurrent AF/AT. Most (86%) AF/AT recurrences occurred ≤ 1 year after the first procedure. Mean time to recurrence was 6 ± 10 months. Kaplan-Meier analysis on antiarrhythmics showed AF free rate of 87% at 1 year and 80% at 4 years. There were no major complications.
PVAI is an effective strategy for the prevention of AF in the majority of patients with PAF. Maintenance of SR requires repeat procedure or continuation of AADs in a significant proportion of patients. After maintenance of sinus rhythm 1-year post-PVAI, a minority of patients will subsequently develop late recurrence of AF.
肺静脉在触发心房颤动（AF）中起着重要作用。肺静脉隔离（PVI）是阵发性 AF 患者的有效治疗方法。然而，在环肺静脉窦隔离（PVAI）的长期随访中，AF 复发的晚期复发率并未得到很好的记录。我们旨在确定 PVAI 后心律失常复发的时间，并确定环肺静脉窦隔离后窦性节律的长期比率。
分析了 100 例平均年龄为 54 ± 10 岁的阵发性 AF 患者，这些患者接受了 PVAI 手术。肺静脉隔离基于电生理和解剖方法，使用非透视导航映射系统指导窦房结 PVI。消融终点是在第一次和随后的程序中使用圆形映射导管确认静脉隔离。消融后 1 年内每 3 个月，此后每 6 个月进行一次临床，心电图和动态心电图随访，如果有症状则进行额外的延长监测。记录心律失常复发的时间和代表心律失常的时间。
97％的患者成功隔离了所有 4 条静脉，每条静脉隔离 3.9 ± 0.3 条/患者。最后一次 RF 手术后的随访平均为 39 ± 10 个月（范围 21-66 个月）。在单次手术后，49％的患者无需使用抗心律失常药物（AAD）即可长期维持窦性节律。在重复手术后，57％的患者无需使用 AAD 即可维持窦性节律，而包括使用 AAD 的患者中有 82％可维持窦性节律。总共 100 例患者中有 18 例进行了 2 次手术，100 例中有 4 例进行了 3 次手术，以治疗复发性 AF/AT。大多数（86％）AF/AT 复发发生在首次手术后≤1 年内。平均复发时间为 6 ± 10 个月。抗心律失常药物的 Kaplan-Meier 分析显示，第 1 年的 AF 无复发率为 87％，第 4 年的 AF 无复发率为 80％。没有发生重大并发症。
PVAI 是预防大多数 PAF 患者 AF 的有效策略。在很大一部分患者中，维持窦性节律需要重复手术或继续使用 AAD。在 PVAI 后 1 年维持窦性节律后，少数患者随后会发生晚期 AF 复发。
