Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany.
Europace. 2018 Jan 1;20(1):58-64. doi: 10.1093/europace/euw378.
Catheter ablation is an established therapy for symptomatic atrial fibrillation (AF). However, outcome data on catheter ablation for AF in young adults is scarce.
From 2005-2014, 85 consecutive young adults (mean age 31 ± 4 years; 69% men) with symptomatic paroxysmal AF (PAF, n = 52) and persistent (Pers) AF (n = 33) underwent pulmonary vein isolation (PVI) [±ablation of complex fractionated atrial electrograms/linear lesions in PVI non-responders] at our centre. Follow-up was based on outpatient visits including 24-h Holter-ECG at 3, 6 and, 12 months post ablation, and every 12 months thereafter. Recurrence was defined as any AF/atrial tachycardia episode >30s following a 3-month blanking period. Follow-up was available for 74/85 (87%) patients. After a median follow-up of 4.6 years (Q1: 2.6; Q3: 6.6) and a mean of 1.5 ± 0.6 (median 1, range 1-3) ablation procedures 84% [including 13% on previously ineffective antiarrhythmic drugs (AAD)] of patients were in stable SR. Single-procedural 1-year/5-year arrhythmia-free survival was 66% [95% confidence interval (CI): 56-78%]/44% (95% CI: 33-59%), respectively. Structural heart disease [SHD; hazard ratio (HR) 2.79 (95% CI 1.52-5.12), P = 0.001] and obesity [HR 1.10 (95% CI 1.00-1.21) per unit increase in body mass index >27 kg/m2, P = 0.05] independently predicted AF recurrence. Major complications occurred in 6/122 (4.9%) procedures (PV stenosis in 3, cardiac tamponade in 1, stroke in 1, and arterial-venous fistula in 1).
In the majority of very young adults catheter ablation for AF is effective, and associated with an acceptable complication rate. SHD and obesity are predictors for AF recurrence in this population.
导管消融是治疗有症状的心房颤动（房颤）的一种既定疗法。然而，关于年轻患者的房颤导管消融的结果数据却很少。
从 2005 年至 2014 年，85 名连续的有症状阵发性房颤（PAF，n=52）和持续性房颤（Pers，n=33）的年轻成年人（平均年龄 31±4 岁；69%为男性）在我们中心接受了肺静脉隔离（PVI）[±在 PVI 无反应者中进行复杂碎裂心房电图/线性消融]。随访基于门诊就诊，包括消融后 3、6 和 12 个月的 24 小时动态心电图（Holter-ECG），此后每 12 个月一次。复发定义为在 3 个月的空白期后任何>30 秒的房颤/房性心动过速发作。85 名患者中有 74 名（87%）可获得随访。中位随访时间为 4.6 年（Q1：2.6；Q3：6.6），平均进行 1.5±0.6 次（中位数为 1，范围为 1-3）消融治疗。84%[包括 13%的患者此前使用抗心律失常药物（AAD）无效]的患者保持稳定的窦性心律。单次手术 1 年/5 年无心律失常生存率分别为 66%（95%置信区间[CI]：56-78%）/44%（95%CI：33-59%）。结构性心脏病（SHD；风险比[HR]2.79[95%CI 1.52-5.12]，P=0.001）和肥胖（HR 1.10[95%CI 1.00-1.21]，每增加 1 单位体重指数[BMI]>27kg/m2，P=0.05）独立预测房颤复发。122 例（4.9%）手术中发生了 6 例主要并发症（3 例肺静脉狭窄，1 例心脏压塞，1 例卒中，1 例动静脉瘘）。
在大多数非常年轻的成年人中，房颤的导管消融是有效的，且相关并发症发生率可接受。结构性心脏病和肥胖是该人群中房颤复发的预测因素。
