Deutsches Herzzentrum München and 1 Medizinische Klinik, Technische Universität München, Munich, Germany.
Circ Arrhythm Electrophysiol. 2011 Oct;4(5):609-14. doi: 10.1161/CIRCEP.111.963256. Epub 2011 Aug 19.
The aim of the study was to investigate whether the type of arrhythmia recurrence after ablation of persistent atrial fibrillation (AF) has an impact on the maintenance of sinus rhythm after the repeat ablation procedure.
Included were 78 consecutive patients (82% men; mean age, 61±10 years; mean left atrial diameter, 47±4 mm) with persistent AF who underwent ≥1 repeat ablation. The initial ablation procedure had consisted of pulmonary vein isolation with additional substrate modification (ablation of complex fractionated atrial electrograms [n=63] or linear lesions [n=15]). Patients presented for reablation either with persistent atrial tachycardia (AT) (group 1, n=36), persistent AF (group 2, n=37), or paroxysmal AF (group 3, n=5). The primary end point was freedom from any arrhythmia off antiarrhythmic drugs 6 and 9 months after the reablation procedure. Estimated proportions of patients reaching the primary end point were 59% for group 1, 28% for group 2, and 100% for group 3 at 6 months and 51%, 23%, and 100%, for groups 1, 2, and 3, respectively, at 9 months (P=0.002).
In patients presenting for a repeat procedure after ablation of persistent AF, the occurrence of AT is associated with a significantly better outcome compared with recurrent persistent AF. These results suggest that AT might be considered as a step toward sinus rhythm.
本研究旨在探讨持续性心房颤动（AF）消融后心律失常复发的类型是否对重复消融后窦性节律的维持有影响。
纳入了 78 例连续患者（82%为男性；平均年龄 61±10 岁；平均左心房直径 47±4mm），他们均接受了≥1 次重复消融。初始消融程序包括肺静脉隔离，外加基质改良（消融复杂碎裂心房电图[ n=63]或线性病变[ n=15]）。患者因持续性房性心动过速（AT）（第 1 组，n=36）、持续性 AF（第 2 组，n=37）或阵发性 AF（第 3 组，n=5）而再次接受消融。主要终点是在重复消融后 6 个月和 9 个月时，无抗心律失常药物的任何心律失常发生率。6 个月时，第 1 组、第 2 组和第 3 组的患者达到主要终点的比例分别为 59%、28%和 100%；9 个月时，第 1 组、第 2 组和第 3 组的比例分别为 51%、23%和 100%（P=0.002）。
在因持续性 AF 消融后再次接受消融的患者中，AT 的发生与更好的复律结果相关。这些结果提示 AT 可能被视为窦性节律的一个步骤。
