Center for Atrial Fibrillation, the Cleveland Clinic, OH, USA.
Circ Arrhythm Electrophysiol. 2011 Jun;4(3):271-8. doi: 10.1161/CIRCEP.111.962100. Epub 2011 Apr 14.
Atrial fibrillation (AF) ablation is increasingly used in clinical practice. We aimed to study the natural history and long-term outcomes of ablated AF.
We followed 831 patients after pulmonary vein isolation (PVI) performed in 2005. We documented clinical outcomes using our prospective AF registry with most recent update on this group of patients in October 2009. In the first year after ablation, 23.8% had early recurrence. Over long-term follow-up (55 months), only 8.9% had late arrhythmia recurrence defined as occurring beyond the first year after ablation. Repeat ablations in patients with late recurrence revealed conduction recovery in at least 1 of the previously isolated PVs in all of them and right-sided triggers with isoproterenol testing in 55.6%. At last follow-up, clinical improvement was 89.9% (79.4% arrhythmia-free off antiarrhythmic drugs and 10.5% with AF controlled with antiarrhythmic drugs). Only 4.6% continued to have drug-resistant AF. It was possible to safely discontinue anticoagulation in a substantial proportion of patients with no recurrence in the year after ablation (CHADS score ≤2, stroke incidence of 0.06% per year). The procedure-related complication rate was very low.
Pulmonary vein isolation is safe and efficacious for long-term maintenance of sinus rhythm and control of symptoms in patients with drug-resistant AF. It obviates the need for antiarrhythmic drugs, negative dromotropic agents, and anticoagulants in a substantial proportion of patients.
心房颤动（AF）消融术在临床实践中应用越来越广泛。我们旨在研究消融术后 AF 的自然病史和长期结果。
我们对 2005 年进行肺静脉隔离（PVI）后的 831 例患者进行了随访。我们使用前瞻性 AF 登记处记录了临床结果，该登记处对该组患者的最新更新时间为 2009 年 10 月。消融术后第一年，23.8%的患者早期复发。在长期随访（55 个月）中，仅有 8.9%的患者出现晚期心律失常复发，定义为消融术后第一年以后发生的心律失常。对晚期复发患者进行重复消融显示，所有患者至少有 1 条之前隔离的肺静脉恢复了传导，55.6%的患者在异丙肾上腺素测试中出现右侧触发。在最后一次随访时，临床改善率为 89.9%（79.4%的患者抗心律失常药物无心律失常，10.5%的患者 AF 通过抗心律失常药物控制）。只有 4.6%的患者仍有药物抵抗性 AF。在消融术后一年无复发的情况下，可安全地停止抗凝治疗（CHADS 评分≤2，每年卒中发生率为 0.06%）。该手术相关并发症发生率非常低。
肺静脉隔离术安全有效，可长期维持窦性心律，并控制药物抵抗性 AF 患者的症状。它使相当一部分患者无需使用抗心律失常药物、负性变时药物和抗凝剂。
