Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
J Cardiovasc Electrophysiol. 2012 Dec;23(12):1295-301. doi: 10.1111/j.1540-8167.2012.02399.x. Epub 2012 Aug 17.
Early recurrences of atrial tachyarrhythmias (ERAT) are common after atrial fibrillation (AF) ablation, and predict late recurrences (LR). We sought to determine the impact of different ablation strategies on ERAT and LR.
The STAR-AF trial randomized 100 patients with paroxysmal or persistent AF to ablation of complex fractionated electrograms (CFAE) alone, pulmonary vein isolation (PVI) alone, or combined PVI + CFAE. Patients were followed for 12 months. ERAT was defined as any recurrence of AF, atrial tachycardia, or flutter (AT/AFL) >30 seconds during the first 3 months of follow-up. LR was defined as any recurrence of AF/AT/AFL >30 seconds 3-12 months post. Forty-nine patients experienced ERAT. The index ablation strategy was the only independent predictor of ERAT on multivariate analysis (HR 2.24 PVI vs PVI + CFAE; and HR 2.65 CFAE vs PVI + CFAE). Fifty-two patients experienced LR. The presence of ERAT (HR 3.23), the use of antiarrhythmic drug (AAD) in the first 3 months postablation (HR 2.85), and the index ablation strategy were independently associated with LR (HR 3.42 PVI vs PVI + CFAE; HR 4.72 CFAE vs PVI + CFAE). Thirty-five of 49 (71%) patients with ERAT and 17 (33%) of 51 patients without ERAT had LR (P < 0.0001). Among patients with ERAT, increased left atrium size (HR 1.08), the use of AAD in the first 3 months postablation (HR 2.86) and the index ablation strategy were independently associated with LR (HR 4.77 PVI vs PVI + CFAE; HR 4.45 CFAE vs PVI + CFAE).
ERAT is common following AF ablation and is strongly associated with LR. Although CFAE ablation alone results in higher rates of early and LR, the addition of CFAE to PVI results in increased long-term success without an increase in ERAT.
心房颤动（AF）消融后早期复发性房性心动过速（ERAT）很常见，并且预测晚期复发（LR）。我们旨在确定不同消融策略对 ERAT 和 LR 的影响。
STAR-AF 试验将 100 例阵发性或持续性 AF 患者随机分为单纯复杂碎裂电图（CFAE）消融、单纯肺静脉隔离（PVI）或 PVI+CFAE 联合消融。患者随访 12 个月。ERAT 定义为随访前 3 个月内任何 AF、房性心动过速或扑动（AT/AFL）>30 秒的复发。LR 定义为 3-12 个月后任何 AF/AT/AFL>30 秒的复发。49 例患者出现 ERAT。多变量分析显示，索引消融策略是 ERAT 的唯一独立预测因素（PVI 与 PVI+CFAE 相比 HR 为 2.24；CFAE 与 PVI+CFAE 相比 HR 为 2.65）。52 例患者出现 LR。ERAT 的存在（HR 3.23）、消融后 3 个月内使用抗心律失常药物（AAD）（HR 2.85）和索引消融策略与 LR 独立相关（PVI 与 PVI+CFAE 相比 HR 为 3.42；CFAE 与 PVI+CFAE 相比 HR 为 4.72）。49 例 ERAT 患者中有 35 例（71%）和 51 例无 ERAT 患者中有 17 例（33%）出现 LR（P<0.0001）。在出现 ERAT 的患者中，左心房增大（HR 1.08）、消融后 3 个月内使用 AAD（HR 2.86）和索引消融策略与 LR 独立相关（PVI 与 PVI+CFAE 相比 HR 为 4.77；CFAE 与 PVI+CFAE 相比 HR 为 4.45）。
AF 消融后 ERAT 很常见，与 LR 密切相关。尽管单纯 CFAE 消融导致早期和 LR 发生率较高，但 CFAE 加 PVI 可增加长期成功率，而不会增加 ERAT。
