不同终止模式对持续性心房颤动导管消融中房颤终止的影响。
Impact of different termination modes on atrial fibrillation termination in catheter ablation of persistent atrial fibrillation.
机构信息
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
出版信息
Chin Med J (Engl). 2012 Jun;125(11):1877-83.
BACKGROUND
The optimal endpoint for catheter ablation of persistent atrial fibrillation (AF) remains ambiguous. This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome.
METHODS
Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion (CV) group. Subgroups were also analyzed based on different termination modes. Follow-up assessment included early recurrence and sinus rhythm (SR) maintenance.
RESULTS
During initial ablation, 33 patients (11.3%) were directly converted to SR, 166 patients (56.7%) were converted to atrial tachycardia (AT) that subsequently restored SR with further ablation in 98 patients (33.4%), and a total of 162 patients (55.3%) underwent cardioversion due to persistent atrial arrhythmias. Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence (38.2% vs. 43.8%, P = 0.328) and SR maintenance (67.2% vs. 59.8%, P = 0.198) during the (23 ± 7) months follow-up. Even after repeat ablation, the SR maintenance continued to exhibit no statistical difference in above two groups (72.5% vs. 70.4%, P = 0.686). Further analysis of subgroups, however, demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups (P < 0.05). Furthermore, atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode: AF or AT (P < 0.05).
CONCLUSIONS
Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF. AF methods that convert arrhythmia directly to SR have, however, been linked with improved clinical outcomes, although conversions to AT may not be correlated. Atrial arrhythmias observed during the ablation may be used to predict the recurrence mode.
背景
持续性心房颤动（房颤）导管消融的最佳终点仍不明确。本研究旨在探讨消融终止作为手术终点以及终止方式对长期临床结果的影响。
方法
293 例行逐步消融治疗持续性房颤的患者分为消融终止组和电复律（CV）组。还根据不同的终止方式进行了亚组分析。随访评估包括早期复发和窦性节律（SR）维持。
结果
在初始消融过程中，33 例（11.3%）患者直接转为 SR，166 例（56.7%）患者转为房性心动过速（AT），其中 98 例（33.4%）进一步消融后恢复 SR，共有 162 例（55.3%）患者因持续性房性心律失常行电复律。在表现为 AF 或 AT 的患者中，消融终止组和电复律终止组之间的早期复发（38.2% vs. 43.8%，P = 0.328）和 SR 维持（67.2% vs. 59.8%，P = 0.198）无显著差异。即使在重复消融后，两组的 SR 维持率仍无统计学差异（72.5% vs. 70.4%，P = 0.686）。然而，进一步的亚组分析表明，直接转为 SR 的 AF 患者的临床结局优于其他亚组（P < 0.05）。此外，消融过程中出现的房性心律失常与复发模式的预测有关：AF 或 AT（P < 0.05）。
结论
作为手术终点的终止与持续性房颤患者的长期 SR 维持无关。然而，将心律失常直接转为 SR 的 AF 方法与改善的临床结局相关，尽管转为 AT 可能与终止方式无关。消融过程中观察到的房性心律失常可用于预测复发模式。
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