Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan.
J Cardiovasc Electrophysiol. 2012 Sep;23(9):955-61. doi: 10.1111/j.1540-8167.2012.02337.x. Epub 2012 May 3.
Long-Term Outcome of SVC AF Ablation.
Data of the long-term clinical outcome after superior vena cava (SVC) isolation are limited. We aimed to evaluate the long-term outcome in patients with atrial fibrillation (AF) who had triggers originating from the SVC and received catheter ablation of AF.
The study consisted of 68 patients (age 56 ± 12 years old, 32 males) who underwent the ablation procedure for drug-refractory, symptomatic paroxysmal AF originating from the SVC since 1999. Group 1 consisted of 37 patients with AF initiated from the SVC only, and group 2 consisted of 31 patients with both SVC and pulmonary vein (PV) triggers. During a follow-up period of 88 ± 50 months, the AF recurrence rate was 35.3% after a single procedure. The freedom-from-AF rates were 85.3% at 1 year and 73.3% at 5 years. In the baseline study, group 2 had larger left atrium (38 ± 4 mm vs 36 ± 5 mm, P = 0.04), left ventricle (50 ± 5 mm vs 46 ± 5 mm, P = 0.003), and PV diameters. Kaplan-Meier survival analysis showed a higher AF recurrence rate in group 2 compared to that in group 1 (P = 0.012). The independent predictor of an AF recurrence was a larger SVC diameter (P = 0.02, HR 1.4, 95% CI 1.1-1.8).
Among the patients with paroxysmal AF originating from the SVC, 73% remained free of AF for 5 years after a single catheter ablation procedure. Superior vena cava isolation without PV isolation is an acceptable therapeutic strategy in those patients with AF originating from the SVC only. The SVC diameter was an independent predictor of AF recurrence. (J Cardiovasc Electrophysiol, Vol. 23, pp. 955-961, September 2012).
上腔静脉房颤消融的长期结果。
上腔静脉（SVC）隔离后长期临床结果的数据有限。我们旨在评估患有源自 SVC 的房颤（AF）且接受 AF 导管消融的患者的长期结果。
该研究包括 68 名患者（年龄 56±12 岁，32 名男性），他们自 1999 年以来因药物难治性、有症状的阵发性源自 SVC 的 AF 接受消融手术。第 1 组由 37 名仅源自 SVC 的 AF 患者组成，第 2 组由 31 名 SVC 和肺静脉（PV）触发的患者组成。在 88±50 个月的随访期间，单次手术后 AF 复发率为 35.3%。1 年时的无 AF 率为 85.3%，5 年时为 73.3%。在基线研究中，第 2 组的左心房（38±4mm 比 36±5mm，P=0.04）、左心室（50±5mm 比 46±5mm，P=0.003）和 PV 直径均较大。Kaplan-Meier 生存分析显示，与第 1 组相比，第 2 组的 AF 复发率更高（P=0.012）。AF 复发的独立预测因子是较大的 SVC 直径（P=0.02，HR 1.4，95%CI 1.1-1.8）。
在源自 SVC 的阵发性 AF 患者中，73%的患者在单次导管消融后 5 年内无 AF。对于仅源自 SVC 的 AF 患者，SVC 隔离而不进行 PV 隔离是一种可接受的治疗策略。SVC 直径是 AF 复发的独立预测因子。（J 心血管电生理学，第 23 卷，第 955-961 页，2012 年 9 月）。
