Daly Matthew, Melton Iain, Crozier Ian G
Department of Cardiology, Christchurch Hospital, PO Box 4345, Christchurch, New Zealand.
N Z Med J. 2011 Sep 23;124(1343):39-47.
To report the long-term results following percutaneous pulmonary vein ablation (PVA) for atrial fibrillation (AF) at Christchurch Hospital.
A retrospective observational audit review of outcomes. The sample population included all patients identified as having undergone percutaneous radiofrequency ablation of multiple pulmonary veins at Christchurch Hospital, from the first procedure performed on 29 September 2001 until 15 December 2009.
A total of 187 patients underwent pulmonary vein ablation. The patient population was predominantly younger (mean age 51) and male (83%) with no important comorbidity. Following a single procedure only, the chance of remaining free of AF at 12 months was 0.74 for patients with paroxysmal AF (PAF) and 0.60 for patients with persistent AF (PsAF). 52 patients (28%) underwent a repeat procedure within 12 months of their index ablation owing to early recurrence of AF. 5-year survival free of clinical AF when analysed following these early repeat procedures, if required, was 0.74 and 0.56 for PAF and PsAF patients respectively. Complications occurred following 6% of procedures and were serious in 2.5%. New atrial flutter developed in 6% of patients.
PVA is an effective treatment for AF, with better outcomes in patients with paroxysmal atrial fibrillation. However, as it carries a significant risk, we recommend that its application be reserved for patients with highly symptomatic, medication-refractory disease.
报告克赖斯特彻奇医院经皮肺静脉消融术（PVA）治疗心房颤动（AF）的长期结果。
对结果进行回顾性观察审计。样本人群包括2001年9月29日进行首例手术至2009年12月15日期间在克赖斯特彻奇医院接受多次肺静脉经皮射频消融术的所有患者。
共有187例患者接受了肺静脉消融术。患者群体以年轻人为主（平均年龄51岁），男性占83%，无重要合并症。仅接受一次手术后，阵发性房颤（PAF）患者在12个月时无房颤的几率为0.74，持续性房颤（PsAF）患者为0.60。52例患者（28%）因房颤早期复发在首次消融术后12个月内接受了再次手术。在这些早期再次手术后进行分析时，PAF和PsAF患者5年无临床房颤生存率分别为0.74和0.56。6%的手术出现并发症，严重并发症发生率为2.5%。6%的患者出现新发心房扑动。
PVA是治疗AF的有效方法，对阵发性房颤患者效果更佳。然而，由于其风险较大，我们建议仅用于症状严重、药物难治性疾病患者。
