Pezawas Thomas, Binder Thomas, Ristl Robin, Schneider Barbara, Stojkovic Stefan, Schukro Christoph, Schmidinger Herwig
Department of Cardiology, Medical University of Vienna, Austria.
Department of Cardiology, Medical University of Vienna, Austria.
J Cardiol. 2015 Jun;65(6):479-86. doi: 10.1016/j.jjcc.2014.07.018. Epub 2014 Aug 26.
Pulmonary vein isolation (PVI) has become an accepted therapy for patients with atrial fibrillation (AF) and the indications have widened to include non-paroxysmal AF-patients. Maintenance of sinus rhythm after PVI can be adversely affected by clinical or echocardiographic parameters, which should be clearly identified.
After baseline clinical and echocardiographic evaluations, PVI was performed in patients with paroxysmal or non-paroxysmal AF. The follow-up strategy after PVI included: (1) clinical follow up, 12-lead electrocardiography (ECG) and 24-h ECG every 3 months, (2) trans-telephonic ECGs twice daily and when symptomatic (over 4 weeks) every 3 months, or (3) continuous monitoring via implanted devices. A recurrence was an atrial arrhythmia lasting >30s. All 340 PVI procedures of 229 patients were analyzed. On average, 1.5 PVI procedures per patient (range, 1-6 PVI) were performed. The mean age was 58±11 years (73% male) with 109 paroxysmal and 120 non-paroxysmal AF cases. Clinical follow-up with 12-lead ECGs, 24-h ECGs, trans-telephonic ECGs, and implanted devices was complete in 100%, 63%, 51%, and 16% of cases, respectively. The overall one-year recurrence rate of 59% (range, 24-82%) was dependent on grades of diastolic function (normal - dysfunction grade III) in a multivariable analysis model. Patients with normal diastolic function had the lowest recurrence rates of 24% and 49% after 1 and 3 years of follow-up, respectively (p<0.0001).
Diastolic function could serve as a simple summary predictor for AF recurrence, and would facilitate clinical decision-making in AF treatment.
肺静脉隔离术（PVI）已成为心房颤动（AF）患者公认的治疗方法，其适应证已扩大到包括非阵发性AF患者。PVI术后窦性心律的维持可能会受到临床或超声心动图参数的不利影响，应明确识别这些参数。
在进行基线临床和超声心动图评估后，对阵发性或非阵发性AF患者进行PVI。PVI术后的随访策略包括：（1）临床随访，每3个月进行12导联心电图（ECG）和24小时动态心电图检查；（2）每天两次经电话传输心电图，有症状时（超过4周）每3个月检查一次；或（3）通过植入装置进行连续监测。复发是指持续超过30秒的房性心律失常。对229例患者的340次PVI手术进行了分析。平均每位患者进行1.5次PVI手术（范围为1 - 6次PVI）。平均年龄为58±11岁（73%为男性），其中阵发性AF患者109例，非阵发性AF患者120例。分别有100%、63%、51%和16%的病例完成了12导联心电图、24小时动态心电图、经电话传输心电图和植入装置的临床随访。在多变量分析模型中，总体一年复发率为59%（范围为24 - 82%），取决于舒张功能分级（正常 - 功能障碍III级）。舒张功能正常的患者在随访1年和3年后的复发率最低，分别为24%和49%（p<0.0001）。
舒张功能可作为AF复发的一个简单综合预测指标，有助于AF治疗中的临床决策。
