Miyazaki Shinsuke, Kuwahara Taishi, Takahashi Atsushi
Cardiovascular Center, Yokosuka Kyosai Hospital, Yonegahamadori, Yokosuka-shi, Kanagawa-ken, Japan.
Pacing Clin Electrophysiol. 2012 Oct;35(10):1236-41. doi: 10.1111/j.1540-8159.2012.03487.x. Epub 2012 Aug 16.
Pulmonary vein antral isolation (PVAI) is a recommended treatment for symptomatic drug-refractory paroxysmal atrial fibrillation (PAF). PAF naturally progresses toward persistent AF with an increase in the frequency and duration of AF. The objective of this study was to evaluate whether the preprocedural AF frequency had an impact on the AF recurrence after PVAI in patients with symptomatic PAF.
A total of 362 consecutive patients (61.0 ± 9.8 years; 274 males) with drug-refractory PAF who underwent PVAI were included. The preprocedural frequency of PAF was daily, weekly, monthly, and yearly in 145 (40.1%), 112 (30.9%), 90 (24.9%), and 15 (4.1%) patients, respectively. There were no significant differences in any of the preprocedural variables between the four groups, except for the number of ineffective antiarrhythmic drugs (AADs). PVAI was successfully performed in all patients. At 12 months after the initial procedure, 63.5% of the entire group of patients were free of AF recurrences without any AADs, respectively. A Cox regression multivariate analysis of the variables including the AF frequency, age, gender, duration of AF, presence of hypertension or structural heart disease, left atrial size, left ventricular ejection fraction, and body mass index demonstrated that the AF frequency was not an independent predictor of AF recurrence after a single ablation procedure (P = 0.194).
This study demonstrated that the preprocedural AF frequency did not predict AF recurrence after PVAI in patients with PAF. From the clinical point of view, an additional AF classification based on the preprocedural AF frequency might not be valuable in patients undergoing PVAI.
肺静脉前庭隔离术（PVAI）是有症状的药物难治性阵发性心房颤动（PAF）的推荐治疗方法。PAF会随着房颤频率和持续时间的增加自然进展为持续性房颤。本研究的目的是评估术前房颤频率对有症状PAF患者PVAI术后房颤复发是否有影响。
共纳入362例连续接受PVAI的药物难治性PAF患者（61.0±9.8岁；男性274例）。术前PAF频率为每日、每周、每月和每年的患者分别有145例（40.1%）、112例（30.9%）、90例（24.9%）和15例（4.1%）。除无效抗心律失常药物（AADs）数量外，四组术前变量均无显著差异。所有患者均成功进行了PVAI。在初次手术后12个月，整个患者组中分别有63.5%的患者在未使用任何AADs的情况下无房颤复发。对包括房颤频率、年龄、性别、房颤持续时间、是否存在高血压或结构性心脏病、左心房大小、左心室射血分数和体重指数等变量进行Cox回归多因素分析表明，房颤频率不是单次消融术后房颤复发的独立预测因素（P=0.194）。
本研究表明，术前房颤频率不能预测PAF患者PVAI术后的房颤复发。从临床角度来看，基于术前房颤频率进行额外的房颤分类对接受PVAI的患者可能没有价值。
