Proietti Riccardo, Hadjis Alexios, AlTurki Ahmed, Thanassoulis George, Roux Jean-François, Verma Atul, Healey Jeff S, Bernier Martin L, Birnie David, Nattel Stanley, Essebag Vidal
McGill University Health Center, Montreal, Quebec, Canada; Cardiology Department, Luigi Sacco Hospital, Milan, Italy.
McGill University Health Center, Montreal, Quebec, Canada.
JACC Clin Electrophysiol. 2015 Jun;1(3):105-115. doi: 10.1016/j.jacep.2015.04.010. Epub 2015 May 13.
The progression from paroxysmal atrial fibrillation (AF) to persistent or long-term persistent forms has recently gained increasing attention. A growing amount of data has shown a significant morbidity and mortality associated with the transition. The aim of our systematic review was to assess the evidence regarding AF progression rates with different management approaches. Electronic databases were searched by using text words and relevant indexing to capture data on AF progression. Studies that considered progression from paroxysmal AF to a persistent or permanent form were included. The papers collected were divided into 2 groups: 1) general population studies (with almost exclusively medical therapy); and 2) studies that consider progression of AF subsequent to AF ablation. Twenty-one studies were included in the first group and 8 in the second group. In the first group, percentage of AF progression at 1 year ranged from 10% to 20%. Studies that included a longer follow-up detected a higher percentage of progression (from 50% to 77% after 12 years). In patients treated with catheter ablation, the percentage of progression was significantly lower (from 2.4% to 2.7% at 5 years' follow-up). The percentage of progression after catheter ablation did not change according to duration of follow-up. AF ablation is associated with significantly reduced progression to persistent forms compared with studies in the general population. Prevention of long-term AF progression may be a clinically relevant outcome after AF ablation. Further research is required to determine whether delaying progression of AF by catheter ablation reduces morbidity and mortality.
阵发性心房颤动（AF）进展为持续性或长期持续性形式最近越来越受到关注。越来越多的数据表明，这种转变与显著的发病率和死亡率相关。我们系统评价的目的是评估不同管理方法下房颤进展率的证据。通过使用文本词和相关索引搜索电子数据库，以获取房颤进展的数据。纳入了考虑从阵发性房颤进展为持续性或永久性形式的研究。收集的论文分为两组：1）一般人群研究（几乎完全采用药物治疗）；2）考虑房颤消融术后房颤进展的研究。第一组纳入21项研究，第二组纳入8项研究。在第一组中，1年时房颤进展的百分比在10%至20%之间。随访时间更长的研究发现进展百分比更高（12年后为50%至77%）。在接受导管消融治疗的患者中，进展百分比显著更低（随访5年时为2.4%至2.7%）。导管消融术后的进展百分比不会随随访时间的延长而改变。与一般人群的研究相比，房颤消融与进展为持续性形式的显著减少相关。预防房颤的长期进展可能是房颤消融术后一个具有临床意义的结果。需要进一步研究以确定通过导管消融延迟房颤进展是否能降低发病率和死亡率。
