Fichtner Stephanie, Sparn Korbinian, Reents Tilko, Ammar Sonia, Semmler Verena, Dillier Roger, Buiatti Alexandra, Kathan Susanne, Hessling Gabriele, Deisenhofer Isabel
Medizinische Klinik I, Klinikum der Universität München, Marchioninistr. 15, Munich 81377, Germany
Deutsches Herzzentrum München, Lazarettstr. 36, Munich 80636, Germany.
Europace. 2015 Sep;17(9):1371-5. doi: 10.1093/europace/euu389. Epub 2015 Feb 18.
In patients with paroxysmal atrial fibrillation (pAF), pulmonary vein isolation (PVI) has become an accepted treatment option with single procedure success rates of 60-80%. A repeat ablation is performed in ∼30% of patients because of arrhythmia recurrence. The strategy for this repeat procedure is not defined.
Patients with pAF recurrence after PVI were prospectively randomized and underwent a second ablation procedure with either PVI of all reconnected veins or PVI with an additional left atrial anterior line. Follow-up in our arrhythmia clinic was every 3 months up to 12 months including 7 day Holter monitoring. A total of 77 patients (mean age 63 ± 9 years, 69% males) were included in the analysis. A repeat PVI was performed in 41 patients, PVI + anterior line in 36 patients. After a follow-up of 12 months, 26 of 41 (63%) patients after repeat PVI and 18 of 36 (50%) patients with PVI + anterior line were in stable sinus rhythm off antiarrhythmic medication (P = 0.26). In most patients (12 of 15 patients with PVI and 14 of 18 patients with PVI + anterior line) with an arrhythmia recurrence after the second procedure, the recurring arrhythmia was paroxysmal AF. In 2 of 15 patients of the PVI group and in 4 of 18 patients of the PVI + anterior line group atypical flutter was the reoccurring arrhythmia (P = NS).
In this prospective randomized trial, patients with a recurrence of paroxysmal AF had no better outcome after repeat PVI + one left atrial line compared with patients with repeat PVI only.
在阵发性心房颤动（pAF）患者中，肺静脉隔离（PVI）已成为一种被认可的治疗选择，单次手术成功率为60%-80%。约30%的患者因心律失常复发需进行再次消融。此次重复手术的策略尚未明确。
对PVI术后pAF复发的患者进行前瞻性随机分组，然后对所有重新连接的静脉进行PVI或附加左心房前壁线性消融术的二次消融手术。在我们的心律失常门诊每3个月进行一次随访，为期12个月，包括7天动态心电图监测。共有77例患者（平均年龄63±9岁，69%为男性）纳入分析。41例患者进行了重复PVI，36例患者进行了PVI+前壁线性消融术。随访12个月后，41例重复PVI患者中有26例（63%）、36例PVI+前壁线性消融术患者中有18例（50%）在停用抗心律失常药物后维持窦性心律稳定（P=0.26）。在大多数二次手术后心律失常复发的患者中（PVI组15例中的12例，PVI+前壁线性消融术组18例中的14例），复发的心律失常为阵发性房颤。PVI组15例患者中有2例、PVI+前壁线性消融术组18例患者中有4例复发的心律失常为非典型房扑（P=无显著性差异）。
在这项前瞻性随机试验中，与仅进行重复PVI的患者相比，阵发性房颤复发患者在重复PVI+一条左心房线性消融术后并未获得更好的治疗效果。
