From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.W., A.M.S., A.M., A.R., P.W., B.R., C.L., T.M., F.S., J.R., S.M., K.-H.K.); University Heart Center Luebeck, Germany (R.R.T., C.-H.H.); Department of Cardiology, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany (A.R.); and Electrophysiology Bremen, Heart Center Bremen, Germany (C.S.).
Circ Arrhythm Electrophysiol. 2018 Feb;11(2):e005250. doi: 10.1161/CIRCEP.117.005250.
Circumferential pulmonary vein isolation (CPVI) is increasingly performed for the treatment of symptomatic drug-refractory paroxysmal atrial fibrillation. Long-term data for >10 years after CPVI are sparse. We investigated the long-term clinical outcome and progression of paroxysmal atrial fibrillation after double-lasso and 3-dimensional electroanatomical mapping-guided CPVI.
From 2003 to 2004, 161 patients (mean age: 60±10 years) with symptomatic drug-refractory paroxysmal atrial fibrillation were prospectively enrolled and underwent electroanatomical mapping-guided CPVI. Right-sided and left-sided continuous circular lesions encircling the ipsilateral pulmonary veins were placed with irrigated radiofrequency energy. The procedural end point was the absence of pulmonary vein spikes 30 minutes after CPVI verified by 2 spiral catheters placed within the ipsilateral pulmonary veins (double-lasso technique). Major periprocedural complications occurred in 5 of 161 patients (3.1%). Follow-up was based on outpatient clinic visits, including Holter-ECGs and telephonic interviews. After a single procedure and median follow-up of 129.0 months (interquartile range, 124.7-133.1 months), stable sinus rhythm was present in 53 of 161 (32.9%) patients. Multiprocedural outcome after a mean of 1.73±0.9 procedures and a median follow-up of 123.4 months (interquartile range, 61.0-131.0 months) resulted in stable sinus rhythm in 101 of 161 patients (62.7%). Progression toward persistent atrial fibrillation was observed in 10 of 161 patients (6.2%).
Ten-year single-procedural outcome of CPVI in patients with paroxysmal atrial fibrillation resulted in stable sinus rhythm in 32.9% and in 62.7% of patients after multiple procedures. The progression rate to persistent AF was remarkably low.
环肺静脉隔离（CPVI）越来越多地用于治疗有症状的药物难治性阵发性心房颤动。CPVI 后 10 年以上的长期数据很少。我们研究了双套圈和三维电解剖标测引导下 CPVI 后阵发性心房颤动的长期临床结果和进展。
2003 年至 2004 年，前瞻性纳入 161 例有症状的药物难治性阵发性心房颤动患者（平均年龄：60±10 岁），并进行电解剖标测引导下 CPVI。使用灌流射频能量放置围绕同侧肺静脉的右侧和左侧连续环形损伤。CPVI 后 30 分钟，通过放置在同侧肺静脉内的 2 个螺旋导管（双套圈技术）验证无肺静脉尖峰时，达到程序终点。161 例患者中有 5 例（3.1%）发生主要围手术期并发症。随访基于门诊就诊，包括动态心电图和电话访谈。在单次手术和中位随访 129.0 个月（四分位距，124.7-133.1 个月）后，161 例患者中有 53 例（32.9%）维持窦性心律。在平均 1.73±0.9 次手术和中位随访 123.4 个月（四分位距，61.0-131.0 个月）后，161 例患者中有 101 例（62.7%）维持窦性心律。161 例患者中有 10 例（6.2%）进展为持续性心房颤动。
阵发性心房颤动患者 CPVI 的 10 年单次手术结果显示，窦性心律稳定率为 32.9%，多次手术后为 62.7%。持续性房颤的进展率显著较低。
