Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 48109-5853, USA.
J Cardiovasc Electrophysiol. 2012 Jan;23(1):9-14. doi: 10.1111/j.1540-8167.2011.02137.x. Epub 2011 Aug 1.
The objective was to determine the effect of radiofrequency catheter ablation (RFA) on progression of paroxysmal atrial fibrillation (AF).
Progression to persistent AF may occur in up to 50% of patients with paroxysmal AF receiving pharmacological therapy. Hypertension, age, prior transient ischemic event, chronic obstructive pulmonary disease, and heart failure (HATCH score) have been identified as independent risk factors for progression of AF.
RFA was performed in 504 patients (mean age: 58 ± 10 years) to eliminate paroxysmal AF. A repeat RFA procedure was performed in 193 patients (38%). Clinical variables predictive of outcome and their relation to progression of AF after RFA were assessed using multivariate analysis.
At a mean follow-up of 27 ± 12 months after RFA, 434/504 patients (86%) were in sinus rhythm; 49/504 patients (9.5%) continued to have paroxysmal AF; and 14 (3%) were in atrial flutter. Among the 504 patients, 7 (1.5%) progressed to persistent AF. In patients with recurrent AF after RFA, paroxysmal AF progressed to persistent AF in 7/56 (13%, P < 0.001). The progression rate of AF was 0.6% per year after RFA (P < 0.001 compared to 9% per year reported in pharmacologically treated patients). Age >75 years, duration of AF >10 years and diabetes were independent predictors of progression to persistent AF. The HATCH score was not significantly different between patients with paroxysmal AF who did and did not progress to persistent AF (0.7 ± 0.8 vs 1.0 ± 0.5, P = 0.3).
Compared to a historical control group of pharmacologically treated patients with paroxysmal AF, RFA appears to reduce the rate of progression of paroxysmal AF to persistent AF. Age, duration of AF, and diabetes are independent risk factors for progression to persistent AF after RFA.
确定射频导管消融（RFA）对阵发性心房颤动（AF）进展的影响。
接受药物治疗的阵发性 AF 患者中，多达 50%可能会进展为持续性 AF。高血压、年龄、既往短暂性脑缺血发作、慢性阻塞性肺疾病和心力衰竭（HATCH 评分）已被确定为 AF 进展的独立危险因素。
对 504 例（平均年龄：58 ± 10 岁）患者进行 RFA 以消除阵发性 AF。对 193 例（38%）患者进行了重复 RFA 手术。使用多变量分析评估预测结果的临床变量及其与 RFA 后 AF 进展的关系。
在 RFA 后平均 27 ± 12 个月的随访中，504 例患者中有 434/504 例（86%）处于窦性心律；504 例患者中有 49/504 例（9.5%）持续发生阵发性 AF；14 例（3%）发生心房扑动。在 504 例患者中，有 7 例（1.5%）进展为持续性 AF。在 RFA 后复发 AF 的患者中，7/56 例（13%，P < 0.001）阵发性 AF 进展为持续性 AF。RFA 后 AF 的进展率为每年 0.6%（与药物治疗患者报告的每年 9%相比，P < 0.001）。年龄>75 岁、AF 持续时间>10 年和糖尿病是进展为持续性 AF 的独立预测因素。阵发性 AF 患者进展为持续性 AF 的 HATCH 评分无显著差异（0.7 ± 0.8 与 1.0 ± 0.5，P = 0.3）。
与接受药物治疗的阵发性 AF 历史对照组相比，RFA 似乎可降低阵发性 AF 进展为持续性 AF 的发生率。年龄、AF 持续时间和糖尿病是 RFA 后进展为持续性 AF 的独立危险因素。
