Wang Qian, Jiang Shi-Li, Liu Xu, Yang Yi-Qing
Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China.
Intern Med. 2016;55(18):2537-47. doi: 10.2169/internalmedicine.55.5790. Epub 2016 Sep 15.
Objective Little is known about the outcome of repeat catheter ablation of long-standing persistent atrial fibrillation (AF) in patients with a total AF duration of more than 2 years. The main objective of this study was to explore the results and factors affecting the clinical success rate of these repeat procedures. Methods We enrolled 99 patients with a total AF duration of more than 2 years and recurrent atrial arrhythmias after the initial catheter ablation of long-standing persistent AF. The enrolled patients were divided into two groups named the AF-recurrence group (50 patients) and the atrial tachycardia (AT)-recurrence group (49 patients) and all underwent a strict follow-up. The quality of life (QOL) and AF-related symptom classification were assessed at baseline and at 24 months post re-ablation. Results After a mean follow-up of 31 months, 30 (30.3%) patients were free from arrhythmia recurrence, and the success rate in the AT-recurrence group was higher than that in the AF-recurrence group (32.7% vs. 28.0%, p=0.614). A Cox regression analysis revealed a CHA2DS2-VASc score ≥3 to be a predictor of recurrence. AF recurrent patients with an abnormal renal function were more prone to undergo a failed procedure. However, an abnormal renal function had no effect on the outcome of the repeat procedure for patients with AT recurrence. At the 24-month follow-up, patients maintaining sinus rhythm (SR) had a significantly improved QOL and AF-related symptoms. Conclusion The success rate of repeat procedures for long-standing persistent AF and a total AF duration of more than 2 years is poor for patients with a CHA2DS2-VASc score ≥3. An impaired renal function has an unfavorable effect on the outcome for patients with AF recurrence. For patients maintaining SR, both the QOL and AF symptomatology improve significantly.
对于房颤总病程超过2年的患者进行长期持续性房颤的重复导管消融术的结果，人们了解甚少。本研究的主要目的是探讨这些重复手术的结果及影响临床成功率的因素。方法：我们纳入了99例房颤总病程超过2年且在首次长期持续性房颤导管消融术后出现复发性房性心律失常的患者。将纳入的患者分为房颤复发组（50例患者）和房性心动过速（AT）复发组（49例患者），并对所有患者进行严格随访。在基线和再次消融术后24个月评估生活质量（QOL）和房颤相关症状分类。结果：平均随访31个月后，30例（30.3%）患者无心律失常复发，AT复发组的成功率高于房颤复发组（32.7%对28.0%，p = 0.614）。Cox回归分析显示CHA2DS2-VASc评分≥3是复发的预测因素。肾功能异常的房颤复发患者更易手术失败。然而，肾功能异常对AT复发患者的重复手术结果无影响。在24个月随访时，维持窦性心律（SR）的患者生活质量和房颤相关症状有显著改善。结论：对于CHA2DS2-VASc评分≥3且房颤总病程超过2年的长期持续性房颤患者，重复手术的成功率较低。肾功能受损对房颤复发患者的手术结果有不利影响。对于维持SR的患者，生活质量和房颤症状均有显著改善。
