Canpolat Uğur, Aytemir Kudret, Yorgun Hikmet, Şahiner Levent, Kaya Ergün Barış, Çay Serkan, Topaloğlu Serkan, Aras Dursun, Oto Ali
Türkiye Yüksek İhtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Europace. 2014 Dec;16(12):1731-7. doi: 10.1093/europace/euu198. Epub 2014 Oct 29.
Catheter-based atrial fibrillation (AF) ablation has become an important therapeutic option in AF patients. Although there has been significant improvent in procedural success, post-procedural AF recurrences are continuing to be a major clinical problem. To the best of our knowledge, the impact of pre-procedural serum uric acid (SUA) level, as a pro-oxidant and pro-inflammatory marker, on AF recurrence following cryoballoon-based AF ablation has never been studied before. The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation.
A total of 363 patients (mean age 53.5 ± 11.2 years, 52.6% male) with symptomatic paroxysmal AF underwent initial cryoablation procedure. Patients were categorized into quartiles on the basis of their pre-procedural SUA assays and follow-up, and the Kaplan-Meier estimation with a log-rank test was used for the analysis of the influence of SUA on the recurrence of AF. Post-ablation blanking period was observed for 3 months. At a mean follow-up of 19.2 ± 6.1 months, 68 patients (18.7%) had developed AF recurrence. Atrial fibrillation recurrence rates from the lowest to the highest SUA quartiles were 2.9, 7.4, 11.8, and 77.9%, respectively (P < 0.001). On multivariate Cox regression analysis, pre-ablation SUA level (HR: 1.96, 95% CI: 1.49-2.59, P < 0.001), left atrial diameter (HR: 1.11, 95% CI: 1.04-1.19, P = 0.002) and early AF recurrence (HR: 4.34, 95% CI: 1.9-9.95, P = 0.001) were independent predictors of AF recurrence after cryoablation. Using a cut-off level of 6.37, the pre-ablation SUA level predicted AF recurrence during follow-up with a sensitivity of 85.7% and a specificity of 83.7%.
In this prospective study of patients with paroxysmal AF undergoing cryoablation, increased pre-ablation SUA levels were associated with a higher rate of AF recurrence. Our results support the role of a pre-ablation pro-inflammatory and pro-oxidant environment in the development of AF recurrence after ablation therapy but suggest that other factors are also important.
基于导管的心房颤动（房颤）消融已成为房颤患者的重要治疗选择。尽管手术成功率有了显著提高，但术后房颤复发仍是一个主要的临床问题。据我们所知，术前血清尿酸（SUA）水平作为一种促氧化剂和促炎标志物，对基于冷冻球囊的房颤消融术后房颤复发的影响此前从未被研究过。本研究的目的是确定SUA水平与导管消融术后阵发性房颤复发之间是否存在关联。
共有363例有症状的阵发性房颤患者（平均年龄53.5±11.2岁，男性占52.6%）接受了初次冷冻消融手术。根据术前SUA检测和随访结果将患者分为四分位数组，并采用Kaplan-Meier估计法和对数秩检验分析SUA对房颤复发的影响。术后观察3个月的空白期。平均随访19.2±6.1个月时，68例患者（18.7%）发生了房颤复发。SUA四分位数从低到高的房颤复发率分别为2.9%、7.4%、11.8%和77.9%（P<0.001）。多因素Cox回归分析显示，术前SUA水平（HR：1.96，95%CI：1.49 - 2.59，P<0.001）、左心房直径（HR：1.11，95%CI：1.04 - 1.19，P = 0.002）和早期房颤复发（HR：4.34，95%CI：1.9 - 9.95，P = 0.001）是冷冻消融术后房颤复发的独立预测因素。以6.37为临界值，术前SUA水平预测随访期间房颤复发的敏感性为85.7%，特异性为83.7%。
在这项对阵发性房颤患者进行冷冻消融的前瞻性研究中，术前SUA水平升高与房颤复发率较高相关。我们的结果支持术前促炎和促氧化环境在消融治疗后房颤复发发展中的作用，但表明其他因素也很重要。
