Osaka Yuki, Takigawa Masateru, Takahashi Atsushi, Kuwahara Taishi, Okubo Kenji, Takahashi Yoshihide, Tanaka Yasuaki, Kawaguchi Naohiko, Yamao Kazuya, Watari Yuji, Nakashima Emiko, Nakajima Jun, Takagi Katsumasa, Fujino Tadashi, Kimura Shigeki, Hikita Hiroyuki, Hirao Kenzo, Isobe Mitsuaki
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Indian Pacing Electrophysiol J. 2017 Sep-Oct;17(5):125-131. doi: 10.1016/j.ipej.2017.07.009. Epub 2017 Jul 19.
Catheter ablation (CA) of paroxysmal atrial fibrillation (PAF) is an effective treatment. However, the frequency of asymptomatic AF recurrence after CA in patients with PAF and sick sinus syndrome (SSS) is not clear. The aim of this study was to elucidate the real AF recurrence after CA in patients with PAF and a pacemaker for SSS.
Fifty-one consecutive patients (mean age 66.6 ± 7.0 years, male 34) with PAF and SSS and pacemakers underwent CA. All patients were followed at 1, 3, 6, 9, and 12 months after the CA using a 12-lead ECG, Holter-ECG, and 1-month event recorder as a conventional follow-up. In addition, the pacemakers were interrogated every 12 months. During a 5-year follow-up after the final CA procedure, AF recurrences were observed in 7 patients (13.7%) with a conventional follow-up, including 1 (2.0%) asymptomatic patient. Pacemaker-interrogation revealed another 10 patients (19.6%) with asymptomatic AF recurrences. Ultimately, the conventional follow-up plus pacemaker-interrogation provided a higher incidence of AF recurrences (P = 0.009). Multiple CA procedures contributed to a significant increase in the AF-free survival rate at 5 years: 58.6% after a single CA and 86.0% after multiple CA procedures with a conventional follow-up, but which decreased to 40.6% and 60.9% with a conventional follow-up plus a pacemaker interrogation, respectively.
One-third of PAF patients with SSS and pacemakers recurred after multiple CA sessions. However, 65% of them were asymptomatic and difficult to be identified with conventional follow-up. Pacemaker interrogation significantly increased the detection rate of AF-recurrence.
阵发性心房颤动（PAF）的导管消融术（CA）是一种有效的治疗方法。然而，PAF合并病态窦房结综合征（SSS）患者CA术后无症状性房颤复发的频率尚不清楚。本研究的目的是阐明PAF合并SSS且植入起搏器患者CA术后房颤的实际复发情况。
51例连续的PAF合并SSS且植入起搏器的患者接受了CA治疗。所有患者在CA术后1、3、6、9和12个月进行随访，采用12导联心电图、动态心电图和1个月事件记录仪作为常规随访手段。此外，每12个月对起搏器进行一次程控。在最后一次CA术后5年的随访中，常规随访发现7例患者（13.7%）发生房颤复发，其中1例（2.0%）为无症状患者。起搏器程控发现另外10例患者（19.6%）有无症状性房颤复发。最终，常规随访加起搏器程控发现的房颤复发率更高（P = 0.009）。多次CA手术使5年无房颤生存率显著提高：单次CA术后为58.6%，多次CA术后常规随访时为86.0%，但常规随访加起搏器程控时分别降至40.6%和60.9%。
三分之一的PAF合并SSS且植入起搏器的患者在多次CA术后复发。然而，其中65%为无症状性复发，常规随访难以发现。起搏器程控显著提高了房颤复发的检出率。
