Ejima Koichiro, Henmi Ryuta, Iwanami Yuji, Yagishita Daigo, Shoda Morio, Hagiwara Nobuhisa
Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
J Cardiovasc Electrophysiol. 2017 Mar;28(3):266-272. doi: 10.1111/jce.13159. Epub 2017 Jan 25.
The guidelines suggest that an adjuvant substrate modification in addition to pulmonary vein isolation (PVI) may be needed for persistent atrial fibrillation (PerAF) assuming that catheter ablation is less successful for PerAF than paroxysmal AF (PAF). To revisit the above assumption, we compared the outcome of the same catheter ablation strategy between PAF and PerAF.
Two hundred and thirty-three consecutive patients (mean age 60 ± 10 years, 53 PerAF and 8 long-lasting PerAF) without structural heart disease underwent catheter ablation of AF by the same strategy using an empiric thoracic vein isolation (a wide circumferential PVI plus empiric superior vena cava isolation) as a major part of the strategy without any adjuvant substrate modification. The duration of AF in the patients with PerAF was 6 ± 4 months. During 25 ± 10 months of follow-up after single procedures, 71 (30%) patients had atrial tachyarrhythmia recurrences without antiarrhythmic drugs. A Kaplan-Meier analysis of the recurrence-free survival rate after a single procedure and after repeat procedures revealed no significant difference between the patients with PAF and those with PerAF (log-rank, P = 0.38 and P = 0.27, respectively). A Cox regression multivariate analysis of the variables including the age, gender, PerAF, body mass index, left ventricular ejection fraction, and left atrial volume index demonstrated that none of the variables were an independent predictor of an atrial tachyarrhythmia recurrence after a single ablation procedure.
In patients without underlying heart disease, the procedural outcome of an empiric thoracic vein isolation is comparable for PAF and PerAF.
指南表明，对于持续性房颤（PerAF），除肺静脉隔离（PVI）外可能还需要辅助性基质改良，这是假设导管消融治疗PerAF的成功率低于阵发性房颤（PAF）。为重新审视上述假设，我们比较了PAF和PerAF采用相同导管消融策略的结果。
233例无结构性心脏病的连续患者（平均年龄60±10岁，53例PerAF和8例长期持续性PerAF）采用相同策略接受房颤导管消融，该策略主要为经验性胸段静脉隔离（广泛环肺静脉隔离加经验性上腔静脉隔离），未进行任何辅助性基质改良。PerAF患者的房颤持续时间为6±4个月。在单次手术后25±10个月的随访期间，71例（30%）患者在未使用抗心律失常药物的情况下出现房性快速性心律失常复发。对单次手术后及重复手术后无复发生存率的Kaplan-Meier分析显示，PAF患者和PerAF患者之间无显著差异（对数秩检验，P分别为0.38和0.27）。对包括年龄、性别、PerAF、体重指数、左心室射血分数和左心房容积指数等变量进行的Cox回归多因素分析表明，这些变量均不是单次消融术后房性快速性心律失常复发的独立预测因素。
在无基础心脏病的患者中，经验性胸段静脉隔离的手术结果在PAF和PerAF中相当。
