Zhao Liang, Xu Kai, Jiang Weifeng, Zhou Li, Wang Yuanlong, Zhang Xiaodong, Wu Shaohui, Liu Xu
Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Int J Cardiol. 2015;190:227-32. doi: 10.1016/j.ijcard.2015.04.186. Epub 2015 Apr 23.
The long-term outcomes, efficacy and safety of catheter ablation in atrial fibrillation (AF) patients with dilated cardiomyopathy (DCM) have not been reported previously.
Forty nine patients with AF (59% longstanding persistent AF, LSP-AF) and DCM were enrolled. Circumferential pulmonary vein ablation (CPVA, paroxysmal AF), bidirectional block of lines and disappearance of complex fractionated atrial electrograms (CFAEs, persistent and LSP-AF) were the endpoints of the index and repeat procedures. Cumulative success rate reached 49% (mean, 1.4 procedures) during the first year, and dropped to 38% at median follow-up of 45 months (range, 36-64 months) for multiple procedures (mean, 1.9 ± 0.8 [1-4]). Incidence of procedural complications was similar to that of conventional procedures. In multivariate analysis, LSP-AF (OR, 7.40 [95% CI, 1.42-38.34]; P = 0.017) and larger left ventricular end-diastolic diameter (OR, 1.24 [95% CI, 1.01-1.52]; P = 0.034) were significant independent predictors of recurrent atrial tachyarrhythmia (ATa). Compared with patients with ATa recurrence, those free from ATa had better New York Heart Association functional class, 6-minute walk distance and left ventricular ejection fraction during long-term follow-up compared with pre-ablation, but this improvement was not sustained beyond 3 years.
In patients with DCM, current commonly used ablation strategies including CPVA, linear ablation and CFAE ablation are not associated with long-term AF treatment success up to five years. Freedom from ATa is associated with improved heart failure during but not beyond 3 years post ablation.
此前尚未报道过导管消融术治疗扩张型心肌病（DCM）合并心房颤动（AF）患者的长期疗效、有效性及安全性。
纳入49例AF（59%为长期持续性AF，LSP-AF）合并DCM患者。环肺静脉消融（CPVA，阵发性AF）、线性双向阻滞及碎裂电位消失（CFAEs，持续性及LSP-AF）为初次及重复手术的终点。第一年累积成功率达49%（平均1.4次手术），多次手术（平均1.9±0.8[1-4]次）后，在中位随访45个月（范围36-64个月）时降至38%。手术并发症发生率与传统手术相似。多因素分析中，LSP-AF（OR，7.40[95%CI，1.42-38.34]；P=0.017）及较大的左心室舒张末期内径（OR，1.24[95%CI，1.01-1.52]；P=0.034）是房性快速性心律失常（ATa）复发的显著独立预测因素。与ATa复发患者相比，无ATa复发的患者在长期随访中纽约心脏协会心功能分级、6分钟步行距离及左心室射血分数较消融术前有所改善，但这种改善在3年后未持续。
在DCM患者中,目前常用的消融策略包括CPVA、线性消融和CFAE消融在长达五年的时间里并不能带来AF治疗的长期成功。无ATa与消融术后3年内心力衰竭改善相关，但3年后并非如此。
