Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Heart Rhythm. 2012 Aug;9(8):1185-91. doi: 10.1016/j.hrthm.2012.03.007. Epub 2012 Mar 7.
Catheter ablation of paroxysmal atrial fibrillation has been performed for more than 10 years. However, data about the long-term results were limited.
To evaluate the long-tem efficacy following paroxysmal atrial fibrillation ablation and to investigate whether there were different patterns of recurrences in patients with different CHADS(2) scores.
A total of 238 patients with paroxysmal atrial fibrillation who received a catheter ablation from 2004 to 2007 were enrolled. Free of recurrence was defined as the absence of atrial arrhythmias without using any antiarrhythmic agents after ablation.
There were 121 patients (50.8%) suffering from recurrences after the first ablation procedure during a median follow-up period of 5 years. The CHADS(2) score and left atrial diameter were significant predictors of recurrences in the multivariate analysis. Different patterns of recurrence were observed in different groups of patients categorized on the base of CHADS(2) score. Among patients with a CHADS(2) score of ≥3 without recurrences at 2 years postablation, 63.6% experienced episodes of arrhythmias during the subsequent follow-up period. In contrast, in patients with a CHADS(2) score of 0 without recurrences at 2 years postablation, the future recurrence rate was only 2.7%.
After a successful ablation, recurrences may continue to occur without reaching a plateau during the long-term follow-up, especially in patients with a high CHADS(2) score. The optimal follow-up strategy may differ and should be individualized for patients with different scores.
阵发性心房颤动的导管消融已经开展了 10 多年。然而，关于长期结果的数据有限。
评估阵发性心房颤动消融后的长期疗效，并探讨 CHADS₂评分不同的患者是否存在不同的复发模式。
共纳入 2004 年至 2007 年接受导管消融的 238 例阵发性心房颤动患者。无复发定义为消融后无抗心律失常药物治疗的情况下无房性心律失常。
在中位随访 5 年期间，首次消融后有 121 例（50.8%）患者复发。CHADS₂评分和左心房直径是多因素分析中复发的显著预测因素。根据 CHADS₂评分将患者分为不同组后，观察到不同的复发模式。在 CHADS₂评分≥3 且 2 年无复发的患者中，63.6%在随后的随访期间出现心律失常发作。相比之下，在 CHADS₂评分为 0 且 2 年无复发的患者中，未来的复发率仅为 2.7%。
在成功消融后，即使达到平台期，在长期随访中也可能会继续出现复发，尤其是在 CHADS₂评分较高的患者中。对于不同评分的患者，可能需要采用不同的最佳随访策略，并进行个体化治疗。
