Kettering Klaus, Gramley Felix
Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Heidelberger Praxisklinik für Innere Medizin, Kardiologie und Pneumologie, Heidelberg, Germany.
Herzschrittmacherther Elektrophysiol. 2018 Mar;29(1):133-140. doi: 10.1007/s00399-017-0498-y. Epub 2017 Apr 26.
Catheter ablation has become the first line therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favorable (especially in patients with persistent atrial fibrillation). Therefore, more complex ablation strategies and the usefulness of (short-term) adjunctive antiarrhythmic drug therapy are a matter of discussion. The aim of this study was to analyze whether short-term amiodarone therapy after catheter ablation (3 months) has a positive effect on the success rates after circumferential pulmonary vein ablation in patients with persistent atrial fibrillation.
A total of 230 consecutive patients with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure (using the NAVX or CARTO system). Catheter ablation of the right or left atrial isthmus and a linear lesion in the roof of the left atrium were only performed in selected patients with documented episodes of atrial fibrillation. In 115 patients, a short-term adjunctive antiarrhythmic drug therapy with amiodarone was initiated immediately prior to the ablation procedure (for the first 3 months group A). In the remaining 115 patients, no antiarrhythmic drug therapy was administered except for beta blockers (group B).
Out of 115 patients 19 (16.5%) in group A and 34 (29.6%) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring electrical cardioversion (P = 0.03; blanking period). One year after the ablation procedure 81.7% of patients in group A (94/115) and 73.0% of patients in group B (84/115) were free from further arrhythmia recurrences (P = 0.16). The success rate 2 years after catheter ablation was 76.5% (no arrhythmia recurrence in 88/115 patients) in group A and 63.5% in group B (no arrhythmia recurrence in 73/115 patients; P = 0.04). There were no major complications during long-term follow-up.
Adjunctive short-term amiodarone therapy improves the success rate after catheter ablation of persistent atrial fibrillation during long-term follow-up. This might be due to a decreased incidence of early arrhythmia recurrences after catheter ablation of atrial fibrillation and an improved reverse remodelling process.
导管消融已成为有症状、复发性、药物难治性心房颤动患者的一线治疗方法。环肺静脉消融仍是这些患者的标准治疗方法。然而，结果并不十分理想（尤其是在持续性心房颤动患者中）。因此，更复杂的消融策略以及（短期）辅助抗心律失常药物治疗的有效性成为讨论的话题。本研究的目的是分析导管消融后（3个月）短期胺碘酮治疗对持续性心房颤动患者环肺静脉消融成功率是否有积极影响。
总共230例有症状的持续性心房颤动患者连续接受了环肺静脉消融手术（使用NAVX或CARTO系统）。仅在记录有心房颤动发作的特定患者中进行右心房或左心房峡部的导管消融以及左心房顶部的线性病变。在115例患者中，在消融手术前立即开始使用胺碘酮进行短期辅助抗心律失常药物治疗（前3个月为A组）。在其余115例患者中，除β受体阻滞剂外未给予抗心律失常药物治疗（B组）。
在115例患者中，A组有19例（16.5%），B组有34例（29.6%）在消融后的前3个月内出现心律失常复发，需要进行电复律（P = 0.03；空白期）。消融手术后1年，A组81.7%的患者（94/115）和B组73.0%的患者（84/115）未再出现心律失常复发（P = 0.16）。导管消融2年后，A组的成功率为76.5%（88/115例患者无心律失常复发），B组为63.5%（73/115例患者无心律失常复发；P = 0.04）。长期随访期间无重大并发症。
辅助短期胺碘酮治疗可提高长期随访期间持续性心房颤动导管消融后的成功率。这可能是由于心房颤动导管消融后早期心律失常复发的发生率降低以及逆向重构过程得到改善。
