Hôpital Cardiologique du Haut Lévêque, Bordeaux-Pessac, France.
Heart Rhythm. 2012 Jul;9(7):1025-30. doi: 10.1016/j.hrthm.2012.02.016. Epub 2012 Feb 15.
Catheter ablation of persistent atrial fibrillation (AF) is associated with longer procedure times and lower long-term success rates than that of paroxysmal AF.
To test the hypothesis that restoration/maintenance of sinus rhythm (SR) preablation would facilitate AF termination and improve outcomes in patients with persistent AF.
We conducted a 2-group cohort study of consecutive patients with persistent AF and SR restored for at least 1 month prior to ablation (SR group; n = 40) and controls matched by age, sex, and AF duration (control group; n = 40). Radiofrequency stepwise catheter ablation was performed in AF for both groups (induced and spontaneous, respectively). Success was defined as freedom from atrial tachyarrhythmia without antiarrhythmic drugs beyond 1 year of follow-up.
During the index ablation procedure, AF cycle length was longer in the SR group than in the control group (183 ± 32 ms vs 166 ± 20 ms; P = .06), suggestive of reverse remodeling. In the SR group, AF more frequently terminated during ablation (95.0% vs 77.5%; P <.05) and required less extensive ablation of complex fractionated electrograms (40.0% vs 87.5%; P <.001) and linear lesions (42.5% vs 82.5%; P <.001). Mean procedural (199.8 ± 69.8 minutes vs 283.5 ± 72.3 minutes; P <.001), fluoroscopy (51.0 ± 24.9 minutes vs 96.3 ± 32.1 minutes; P <.001), and radiofrequency energy delivery (47.5 ± 18.9 minutes vs 97.0 ± 30.6 minutes; P <.001) times were shorter in the SR group. Clinical success rates were similar between groups for first (55.0% vs 45.0%; P = .28) and last (80.0% vs 70.0%; P = .28) procedures, during similar follow-up periods (21.1 ± 9.7 months).
Restoration of SR prior to catheter ablation for persistent AF whenever possible decreases the extent of ablation with the same high clinical efficacy.
与阵发性房颤相比，持续性房颤的导管消融术与更长的手术时间和更低的长期成功率相关。
本研究旨在检验这样一个假设，即在消融前恢复/维持窦性心律（SR）将有助于终止房颤并改善持续性房颤患者的结局。
我们进行了一项连续的 2 组队列研究，纳入了至少在消融前恢复 SR 持续 1 个月的持续性房颤患者（SR 组，n = 40）和年龄、性别和房颤持续时间匹配的对照组（n = 40）。两组均进行房颤射频逐步导管消融（分别为诱发性和自发性）。成功定义为在 1 年以上的随访中，无需抗心律失常药物即可消除房性快速心律失常。
在指数消融过程中，SR 组的房颤周期长度长于对照组（183 ± 32 ms 比 166 ± 20 ms；P =.06），提示反向重构。在 SR 组中，AF 在消融过程中更频繁地终止（95.0%比 77.5%；P <.05），需要更少的复杂碎裂电图消融（40.0%比 87.5%；P <.001）和线性消融（42.5%比 82.5%；P <.001）。SR 组的平均手术时间（199.8 ± 69.8 分钟比 283.5 ± 72.3 分钟；P <.001）、透视时间（51.0 ± 24.9 分钟比 96.3 ± 32.1 分钟；P <.001）和射频能量输送时间（47.5 ± 18.9 分钟比 97.0 ± 30.6 分钟；P <.001）均较短。两组在第一次（55.0%比 45.0%；P =.28）和最后一次（80.0%比 70.0%；P =.28）手术中的临床成功率相似，且随访时间相似（21.1 ± 9.7 个月）。
尽可能在持续性房颤导管消融前恢复 SR，可减少消融范围，同时保持较高的临床疗效。
