Cardiovascular Medicine and Cardiac Arrhythmias, East Palo Alto, California, USA.
Am J Cardiol. 2011 Aug 1;108(3):374-9. doi: 10.1016/j.amjcard.2011.03.055. Epub 2011 May 19.
Current ablation consensus documents define persistent atrial fibrillation (AF) as AF lasting >1 week to 1 year or AF requiring cardioversion or pharmacologic conversion in <1 week. These 2 persistent AF subgroups may have different clinical characteristics and ablation outcomes. We compared 179 patients whose persistent AF was always terminated in <1 week by cardioversion/drugs to 244 whose AF actually lasted >1 week to 1 year. Patients with AF termination in <1 week by cardioversion/drugs had smaller left atrial (LA) size (4.1 ± 0.6 vs 4.5 ± 0.7 cm, p <0.0001), a longer AF history (7.5 ± 7.5 vs 6.0 ± 7.2 years, p = 0.035), more failed drugs (1.6 ± 1.0 vs 1.3 ± 1.0, p = 0.004), lower body mass index (28.5 ± 5.5 vs 30.3 ± 5.5, p = 0.0008), and fewer cardiomyopathies (3.9% vs 11.1%, p = 0.01). Cox multivariate analysis showed that LA size (p = 0.02), female gender (p = 0.001), and coronary artery disease (p = 0.03) predict ablation failure. There was a linear relation between duration of longest AF episode and LA size (p = 0.0001). Longest AF episode duration was the only factor predicting LA size (p = 0.001). Kaplan-Meier analysis showed more patients with AF termination in <1 week by cardioversion/drugs were free of AF after ablation (p = 0.042) than those whose AF actually lasted >1 week to 1 year. Once AF lasted >1 week, duration up to 1 year did not affect ablation success. In conclusion, patients whose persistent AF is always terminated by drugs/cardioversion in <1 week have different clinical characteristics and better ablation outcomes than patients whose AF persists beyond 1 week. This suggests that maintaining sinus rhythm before ablation is beneficial and that the definition of AF2 may need revision.
目前的消融共识文件将持续性房颤（AF）定义为持续时间超过 1 周至 1 年或在 1 周内需要电复律或药物转复的 AF。这两个持续性 AF 亚组可能具有不同的临床特征和消融结果。我们比较了 179 例持续性 AF 患者，这些患者的持续性 AF 始终在 1 周内通过电复律/药物转复终止，与 244 例 AF 实际上持续 1 周至 1 年的患者相比。在 1 周内通过电复律/药物转复终止 AF 的患者左心房（LA）较小（4.1±0.6 对 4.5±0.7 cm，p<0.0001），AF 病史较长（7.5±7.5 对 6.0±7.2 年，p=0.035），药物治疗失败的次数较多（1.6±1.0 对 1.3±1.0，p=0.004），体重指数（BMI）较低（28.5±5.5 对 30.3±5.5，p=0.0008），心肌病较少（3.9%对 11.1%，p=0.01）。Cox 多变量分析显示，LA 大小（p=0.02）、女性性别（p=0.001）和冠状动脉疾病（p=0.03）预测消融失败。最长 AF 发作持续时间与 LA 大小之间存在线性关系（p=0.0001）。最长 AF 发作持续时间是唯一预测 LA 大小的因素（p=0.001）。Kaplan-Meier 分析显示，通过电复律/药物转复在 1 周内终止 AF 的患者在消融后无 AF 发作的比例更高（p=0.042），而那些 AF 实际上持续 1 周至 1 年的患者则没有。一旦 AF 持续超过 1 周，持续时间长达 1 年并不影响消融成功率。总之，在 1 周内通过药物/电复律始终终止的持续性 AF 患者与 AF 持续超过 1 周的患者相比，具有不同的临床特征和更好的消融结果。这表明在消融前保持窦性心律是有益的，并且 AF2 的定义可能需要修订。
