Cardiology Division, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.
Yonsei Med J. 2012 Jan;53(1):76-82. doi: 10.3349/ymj.2012.53.1.76.
Hybrid therapy with catheter ablation of the cavo-tricuspid isthmus (CTI) and continuation of anti-arrhythmic drugs (AAD), or electrical cardioversion with AADs might be alternative treatments for patients with persistent atrial fibrillation (AF). The goal of study was to assess the long term success rate of hybrid therapy for persistent AF compared to antiarrhythmic medication therapy after electrical cardioversion and identify the independent risk factors associated with recurrence after hybrid therapy.
A total of 32 patients with persistent AF who developed atrial flutter after the administration of a class Ic or III anti-arrhythmic drug were enrolled. This group was compared with a group (33 patients) who underwent cardioversion and received direct current cardioversion with AADs. Baseline data were collected, and electrocardiogram and symptom driven Holter monitoring were performed every 2-4 months.
There was no significant difference in the baseline characteristics between the groups. The 12 month atrial arrhythmia free survival was better in the hybrid group, 49.0% vs. 33.1%, p=0.048. However, during a mean 55.7+/- 43.0 months of follow up, the improved survival rate regressed (p=0.25). A larger left atrium size was an independent risk factor for the recurrence of AF after adjusting for confounding factors.
Despite favorable outcome during 12 month, the CTI block with AADs showed outcomes similar to AAD therapy after electrical cardioversion over a 12 month follow up period. Minimal substrate modification with AADs might be an alternative treatment for persistent AF with minimal atrial remodeling.
导管消融腔静脉-三尖瓣峡部（CTI）联合抗心律失常药物（AAD）的杂交治疗，或电复律联合 AAD 可能是持续性心房颤动（AF）患者的替代治疗方法。本研究旨在评估与电复律后抗心律失常药物治疗相比，杂交治疗持续性 AF 的长期成功率，并确定与杂交治疗后复发相关的独立危险因素。
共纳入 32 例在使用 Ic 类或 III 类抗心律失常药物后出现房性心动过速的持续性 AF 患者。将该组与接受电复律和 AAD 直流电复律的一组（33 例）进行比较。收集基线数据，并每 2-4 个月进行心电图和症状驱动的动态心电图监测。
两组间基线特征无显著差异。杂交组 12 个月的心房心律失常无复发生存率较好，为 49.0%比 33.1%，p=0.048。然而，在平均 55.7+/-43.0 个月的随访期间，改善的生存率下降（p=0.25）。左心房大小较大是调整混杂因素后 AF 复发的独立危险因素。
尽管在 12 个月时结果良好，但在调整混杂因素后，AAD 联合 CTI 阻断在 12 个月的随访期间与电复律后 AAD 治疗的结果相似。在最小的心房重构情况下，用 AAD 进行最小的基质修饰可能是持续性 AF 的一种替代治疗方法。
