Hung Yuan, Lo Li-Wei, Lin Yenn-Jiang, Chang Shih-Lin, Hu Yu-Feng, Chung Fa-Po, Tuan Ta-Chuan, Chao Tze-Fan, Liao Jo-Nan, Walia Rohit, Te Abigail Louise D, Yamada Shinya, Lin Chung-Hsing, Chang Yao-Ting, Lin Chin-Yu, Chan Chao-Shun, Liao Ying-Chieh, Raharjo Sunu, Allamsetty Suresh, Chen Shih-Ann
Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
Int J Cardiol. 2017 Aug 15;241:205-211. doi: 10.1016/j.ijcard.2017.04.050. Epub 2017 Apr 21.
There are limited literatures regarding the non-pulmonary vein (NPV) triggers in long-standing persistent atrial fibrillation (LSPAF). The goal of the present study was to investigate the characteristics and long-term outcome of catheter ablation among these patients.
The study included 776 patients (age 53.59±11.38years-old, 556 males) who received catheter ablation for drug-refractory atrial fibrillation (AF). We divided these patients into 3 groups. Group 1 consisted of 579 patients with paroxysmal AF (PAF), group 2 consisted of 103 patients with persistent AF (PerAF) and group 3 consisted of 94 patients with long-standing persistent AF (LSPAF). The average follow-up duration was 28.53±23.21months.
The clinical endpoint was the recurrence of atrial tachyarrhythmia. Among these 3 groups, higher percentages of male (93.6%, P<0.001), NPV triggers (44.7%, P<0.001), longer AF duration (6.65±6.72years, P=0.029), larger left atrium diameter (44.44±6.79mm, P<0.001), and longer procedure time (181.94±70.02min, P<0.001) were noted in LSPAF. After the first catheter ablation, the recurrence rate of AF was highest in LSPAF (Log Rank, P<0.001). Larger left atrium diameters (LAD) (P=0.006; HR: 1.063; CI: 1.018-1.111) and NPV triggers (P=0.035; HR: 1.707; 1.037-2.809) independently predicted AF recurrence in LSPAF.
Compared with PAF and PerAF, LSPAF had a higher incidence of NPV triggers and worse long-term outcome after catheter ablation. NPV triggers and LAD independently predicted AF recurrence after catheter ablation in LSPAF.
关于长期持续性心房颤动（LSPAF）中非肺静脉（NPV）触发因素的文献有限。本研究的目的是调查这些患者导管消融的特征和长期结果。
该研究纳入了776例接受药物难治性心房颤动（AF）导管消融的患者（年龄53.59±11.38岁，男性556例）。我们将这些患者分为3组。第1组包括579例阵发性房颤（PAF）患者，第2组包括103例持续性房颤（PerAF）患者，第3组包括94例长期持续性房颤（LSPAF）患者。平均随访时间为28.53±23.21个月。
临床终点是房性快速性心律失常的复发。在这3组中，LSPAF组男性比例更高（93.6%，P<0.001）、NPV触发因素更多（44.7%，P<0.001）、房颤持续时间更长（6.65±6.72年，P=0.029）、左心房直径更大（44.44±6.79mm，P<0.001）以及手术时间更长（181.94±70.02分钟，P<0.001）。首次导管消融后，LSPAF组房颤复发率最高（Log Rank，P<0.0。左心房直径更大（LAD）（P=0.006；HR：1.063；CI：1.018-1.111）和NPV触发因素（P=0.035；HR：1.707；1.037-2.809）独立预测LSPAF组房颤复发。
与PAF和PerAF相比，LSPAF组NPV触发因素发生率更高，导管消融后的长期结果更差。NPV触发因素和LAD独立预测LSPAF组导管消融后房颤复发。
