State Research Institute of Circulation Pathology, Novosibirsk, Russia.
J Cardiovasc Electrophysiol. 2013 Dec;24(12):1338-43. doi: 10.1111/jce.12245. Epub 2013 Sep 9.
The aim of this prospective randomized study was to compare the efficacy and safety of catheter ablation (CA) versus surgical ablation (SA) in the treatment of paroxysmal and persistent AF after failed initial pulmonary vein isolation procedure.
Patients with a history of symptomatic AF after a previous failed first ablation procedure were eligible for this study. Patients were randomized to CA (n = 32) or SA (n = 32) redo ablation. The primary endpoint was recurrence of atrial tachyarrhythmia at 1 year of follow-up. At the 12-month follow-up, 26 (81%) of the 32 SA group patients and 15 (47%) of the 32 CA group were AF/AT-free on no antiarrhythmic drugs (P = 0.004, log-rank test). In patients with PAF, 17 (85%) patients of the 20 in SA group and 10 (56%) patients of the 18 in CA group were AF-free (P = 0.04, log-rank test). In patients with PersAF, 9 (75%) patients of the 12 in SA group and 5 (36%) patients of the 14 in CA group were AF-free (P = 0.04, log-rank test). The number of the serious adverse event in the SA group was significantly higher (1 CA group vs 7 SA group; P = 0.02).
In patients with PAF and PersAF after failed initial CA, SA is superior to CA for maintenance of sinus rhythm, although serious adverse event rate is significantly higher for SA.
本前瞻性随机研究旨在比较导管消融（CA）与手术消融（SA）治疗初次肺静脉隔离术失败后阵发性和持续性房颤的疗效和安全性。
本研究纳入了既往首次消融失败后出现症状性房颤的患者。患者被随机分为 CA（n=32）或 SA（n=32）再次消融组。主要终点为 1 年随访时心房快速性心律失常的复发情况。在 12 个月的随访中，SA 组 32 例患者中有 26 例（81%）和 CA 组 32 例患者中有 15 例（47%）在不使用抗心律失常药物的情况下无房颤/房性心动过速（P=0.004，对数秩检验）。在 PAF 患者中，SA 组 20 例患者中有 17 例（85%）和 CA 组 18 例患者中有 10 例（56%）无房颤（P=0.04，对数秩检验）。在 PersAF 患者中，SA 组 12 例患者中有 9 例（75%）和 CA 组 14 例患者中有 5 例（36%）无房颤（P=0.04，对数秩检验）。SA 组严重不良事件的数量明显更高（1 例 CA 组 vs 7 例 SA 组；P=0.02）。
在初次 CA 失败后患有 PAF 和 PersAF 的患者中，SA 维持窦性心律优于 CA，但 SA 的严重不良事件发生率明显更高。
