Cardiovascular Center, Clinic im Park, Seestrasse 220, 8027 Zurich, Switzerland.
Int J Cardiol. 2012 May 31;157(2):185-91. doi: 10.1016/j.ijcard.2010.12.010. Epub 2010 Dec 30.
Duty-cycled (DC) radiofrequency ablation (RFA) for atrial fibrillation (AF) has been introduced, however, data on large patient series and comparison to conventional RFA are scarce.
Between 2006 and 2008 DC RFA was performed in 209 consecutive patients (143 (68%) paroxysmal and 66 (32%) persistent AF). As controls served 211 patients, 155 (73%) with paroxysmal and 56 (27%) with persistent AF (p=0.3). In DC RFA, the pulmonary veins (PV) were isolated followed by ablation at the septum and left atrium, if AF persisted. Conventional PV isolation was followed by anatomical lines at the roof and mitral isthmus.
Freedom of paroxysmal AF was demonstrated after 1.08 DC RFA procedures per patient in 82% and after 1.19 conventional procedures in 87% after 8.5 ± 6.5 months (ns). In persistent AF, success rates were 79% after 1.35 DC RFA procedures and 80% after 1.34 conventional procedures after 11.5 ± 8.5 months (ns). The subgroup analysis of 119 patients with follow-up ≥ 12 months (17.5 [14.1-23.6] months) showed similar results. Left atrial flutter occurred in 3% and 8% after paroxysmal AF ablation (p < 0.05) and in 12% and 23% after persistent AF ablation (p=0.1). Multivariate predictors for success in both groups were age, left atrial size, presence of persistent vs. paroxysmal AF and previous pacemaker implantation, but not the ablation technique used. Non-fatal complications were seen in 2.8% with no differences between the groups.
Outcome in DC RFA is similar to conventional RFA with a final success rate exceeding 80% in both paroxysmal and persistent AF in the absence of fatal complications.
duty-cycled（DC）射频消融（RFA）已被用于治疗心房颤动（AF），但关于大样本患者的研究数据以及与传统 RFA 的比较仍然很少。
2006 年至 2008 年期间，对 209 例连续患者（143 例（68％）阵发性和 66 例（32％）持续性 AF）进行了 DC RFA。211 例患者作为对照组，其中 155 例（73％）为阵发性和 56 例（27％）为持续性 AF（p=0.3）。在 DC RFA 中，首先进行肺静脉（PV）隔离，然后在 AF 持续存在的情况下在间隔和左心房进行消融。然后在 PV 常规隔离后进行房顶和二尖瓣峡部解剖线消融。
在 8.5±6.5 个月后，每例患者进行 1.08 次 DC RFA 操作后，阵发性 AF 的无复发率为 82％，进行 1.19 次传统操作后为 87％（无统计学差异）。在持续性 AF 中，进行 1.35 次 DC RFA 操作后成功率为 79％，进行 1.34 次传统操作后成功率为 80％，在 11.5±8.5 个月后（无统计学差异）。对 119 例随访时间≥12 个月（17.5[14.1-23.6]个月）的患者进行亚组分析，结果相似。阵发性 AF 消融后左房扑动发生率为 3％和 8％（p＜0.05），持续性 AF 消融后发生率为 12％和 23％（p=0.1）。两组的成功预测因素均为年龄、左心房大小、持续性 vs. 阵发性 AF 以及先前的起搏器植入，但与所使用的消融技术无关。两组均未发生非致命性并发症。
在没有致命性并发症的情况下，DC RFA 的结果与传统 RFA 相似，阵发性和持续性 AF 的最终成功率均超过 80％。
