使用植入式监测仪检测心律失常复发并选择早期重复导管消融治疗心房颤动的患者：一项试点研究。
Use of an implantable monitor to detect arrhythmia recurrences and select patients for early repeat catheter ablation for atrial fibrillation: a pilot study.
机构信息
State Research Institute of Circulation Pathology, Novosibirsk, Russia.
出版信息
Circ Arrhythm Electrophysiol. 2011 Dec;4(6):823-31. doi: 10.1161/CIRCEP.111.964809. Epub 2011 Sep 19.
BACKGROUND
Catheter ablation of atrial fibrillation (AF) has proved effective in curing highly symptomatic patients with paroxysmal AF. The aim of this prospective, randomized study was to identify the optimal treatment of patients with AF recurrences after the first ablation.
METHODS AND RESULTS
Two hundred eighty-six patients with paroxysmal AF underwent ablation (circumferential pulmonary vein isolation with linear lesions) and were monitored with an implantable cardiac monitor (Reveal XT, Medtronic). Patients without AF recurrences during the 3-month postablation period were assigned to group 1; those with AF recurrences to group 2. Patients in group 2 were randomly assigned to group 3 or group 4. Group 3 patients were treated only with antiarrhythmic drugs for 6 weeks, with no early reablation during the 3-month postablation period. In the case of AF recurrence after the 3-month postablation period, patients underwent reablation. Group 4 patients were treated according to the onset mechanism of AF recurrences, as detected and stored by the implantable cardiac monitor: antiarrhythmic drug therapy, but no reablation if AF was not preceded by triggers; early reablation if premature atrial beats or atrial tachycardias or flutter triggered AF. All patients were followed up for 1 year to assess maintenance of sinus rhythm in each group. On 12-month follow-up examination, of the 119 (42%) patients in group 1, 112 (94%) had no AF recurrences. Among the 83 patients in group 3, only 27 (33%) had no recurrences. Of the 84 group 4 patients, 67 (80%) had no AF recurrences (P<0.0001 versus group 3).
CONCLUSIONS
Patients with recurrences after the first AF ablation are likely to respond to a second early ablation when AF is triggered by supraventricular arrhythmias or premature contractions.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01164319.
背景
导管消融术已被证明对治疗有症状的阵发性房颤（AF）患者有效。本前瞻性、随机研究旨在确定 AF 消融术后首次复发患者的最佳治疗方法。
方法和结果
286 例阵发性 AF 患者接受消融术（环形肺静脉隔离加线性消融），并通过植入式心脏监测仪（Medtronic 公司的 Reveal XT）进行监测。在消融术后 3 个月内无 AF 复发的患者被分配到第 1 组；AF 复发的患者被分配到第 2 组。第 2 组患者随机分为第 3 组或第 4 组。第 3 组患者仅接受抗心律失常药物治疗 6 周，在消融术后 3 个月内无早期再消融。如果在消融术后 3 个月后出现 AF 复发，患者进行再消融。第 4 组患者根据植入式心脏监测仪检测到的和存储的 AF 复发起始机制进行治疗：如果 AF 不是由触发因素引起的，则进行抗心律失常药物治疗，但无触发因素时不进行再消融；如果提前出现房性早搏或房性心动过速或扑动引发 AF，则进行早期再消融。所有患者均随访 1 年，以评估每组患者的窦性节律维持情况。在 12 个月的随访检查中，第 1 组 119 例（42%）患者中，112 例（94%）无 AF 复发。第 3 组 83 例患者中，仅 27 例（33%）无复发。第 4 组 84 例患者中，67 例（80%）无 AF 复发（P<0.0001 与第 3 组相比）。
结论
当 AF 由室上性心律失常或早搏触发时，首次 AF 消融术后复发的患者可能会对第二次早期消融有反应。
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