Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.
Int J Cardiol. 2013 Oct 15;168(6):5372-7. doi: 10.1016/j.ijcard.2013.08.057. Epub 2013 Aug 27.
In our previous prospective and randomized study, we have demonstrated that the concomitant surgical ablation using saline-irrigated cooled tip radiofrequency ablation (SICTRA) system is more effective than subsequent circumferential pulmonary vein isolation (CPVI) combined with substrate modification in treating patients with long-standing persistent atrial fibrillation (LS-AF) and rheumatic heart disease (RHD) undergoing cardiac surgery during middle-term follow-up. Whether this strategy also decreases longer-term arrhythmia recurrence is unknown. This study describes the 4-year efficacy of SICTRA for these patients. Furthermore, we seek to compare the electrophysiological characteristics for recurrent atrial tachyarrhythmia (ATa) at the session of catheter ablation between two groups.
Long-term follow-up was performed in 95 patients who underwent the catheter ablation strategy (n=47, Group A) or SICTRA (n=48, Group B) combined with valvular surgery for symptomatic LS-AF patients with RHD.
After one procedure, Group B had a significantly higher freedom from ATa compared with Group A (29/48 vs 15/47, P=0.005) after a mean follow-up of 54 months (range 48 to 63 months). Catheter-based mapping and ablation of recurrent ATa showed larger amounts of macro-reentrant atrial tachycardias (ATs) in Group B and higher incidence of pulmonary vein (PV) recovery in Group A. After multiple catheter ablations for recurrent ATa, sinus rhythm (SR) could be maintained equally between two groups.
Single procedure success seems to be higher with SICTRA but repeated catheter ablation potentially results in comparable outcomes in treating patients with LS-AF and RHD during long-term follow-up. More macro-reentrant ATs and more PV recoveries are identified to be responsible for ATa in SICTRA and catheter ablation group, respectively.
在我们之前的前瞻性、随机研究中，我们已经证明，在心脏手术期间，同时使用盐水灌洗冷尖端射频消融（SICTRA）系统进行手术消融比随后进行环形肺静脉隔离（CPVI）联合基质改良更有效，用于治疗持续性心房颤动（LS-AF）和风湿性心脏病（RHD）患者。这种策略是否也能降低中期随访中更长时间的心律失常复发尚不清楚。本研究描述了 SICTRA 对这些患者的 4 年疗效。此外，我们试图比较两组患者在导管消融时复发性房性心动过速（ATa）的电生理特征。
对 95 例接受导管消融策略（n=47，A 组）或 SICTRA（n=48，B 组）联合瓣膜手术的 LS-AF 合并 RHD 症状性患者进行长期随访。
在平均随访 54 个月（48-63 个月）后，一次手术后，B 组的复发性 ATa 无事件率明显高于 A 组（29/48 比 15/47，P=0.005）。在导管消融复发性 ATa 后，B 组的大块折返性房性心动过速（AT）较多，A 组的肺静脉（PV）恢复率较高。经过多次导管消融治疗复发性 ATa 后，两组患者的窦性节律（SR）均可维持。
SICTRA 单次手术成功率似乎更高，但在长期随访中，反复进行导管消融可能会导致治疗 LS-AF 和 RHD 患者的结果相当。在 SICTRA 和导管消融组中，分别发现更多的大块折返性 AT 和更多的 PV 恢复与 ATa 有关。
