Zhou Genqing, Chen Songwen, Chen Gang, Zhang Feng, Meng Weidong, Yan Yiwen, Lu Xiaofeng, Wei Yong, Liu Shaowen
Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Jiaotong University, Shanghai, China.
J Cardiovasc Electrophysiol. 2013 Oct;24(10):1092-100. doi: 10.1111/jce.12193. Epub 2013 Jun 21.
The influence of procedural arrhythmia termination on long-term single-procedure clinical outcome in patients with non-paroxysmal atrial fibrillation (AF) remains controversial.
An individualized stepwise ablation strategy was used in 200 consecutive patients with non-paroxysmal AF who underwent first-time radiofrequency catheter ablation, with pulmonary vein isolation and sinus rhythm (SR) restoration as the primary endpoints.
SR was restored by ablation in 94 patients, including 32 with AF directly and 62 with intermediate atrial tachycardia (AT). Cardioversion was performed to restore SR in 106 patients, including 31 with intermediate AT, and 75 with sustained AF. During a mean follow-up of 50.0 ± 9.3 months, single-procedure success was achieved in 99 (49.5%) patients. There was a significant difference in long-term success between patients with SR restoration by ablation and by cardioversion (63.8% vs 36.8%; P < 0.001), but not between patients with AF termination by ablation and by cardioversion (53.6% vs 42.7%; P = 0.146). SR restoration by ablation (odds ratio = 3.032; 95% confidence interval = 1.703-5.398; P < 0.001) was the only predictor of single-procedure success by logistic regression analyses. In patients with intermediate AT (n = 93), AT termination by ablation was associated with a higher success rate than AT termination by cardioversion (62.9% vs 22.6%; P < 0.001).
SR restoration and AT termination by ablation were both associated with an improved long-term single-procedure clinical outcome in patients with non-paroxysmal AF.
在非阵发性心房颤动（AF）患者中，程序性心律失常终止对长期单次手术临床结局的影响仍存在争议。
对200例接受首次射频导管消融的非阵发性AF患者采用个体化逐步消融策略，以肺静脉隔离和窦性心律（SR）恢复作为主要终点。
94例患者通过消融恢复了SR，其中32例直接恢复AF，62例恢复为中间型房性心动过速（AT）。106例患者进行了心脏复律以恢复SR，其中31例为中间型AT，75例为持续性AF。在平均50.0±9.3个月的随访期间，99例（49.5%）患者单次手术成功。通过消融恢复SR的患者与通过心脏复律恢复SR的患者之间长期成功率存在显著差异（63.8%对36.8%；P<0.001），但通过消融终止AF的患者与通过心脏复律终止AF的患者之间无显著差异（53.6%对42.7%；P=0.146）。通过逻辑回归分析，消融恢复SR（比值比=3.032；95%置信区间=1.703-5.398；P<0.001）是单次手术成功的唯一预测因素。在中间型AT患者（n=93）中，消融终止AT的成功率高于心脏复律终止AT（62.9%对22.6%；P<0.001）。
消融恢复SR和终止AT均与非阵发性AF患者长期单次手术临床结局改善相关。
