Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Seoul, Republic of Korea.
Division of Cardiology, Chungbuk National University Hospital, Cheongju, Korea.
PLoS One. 2018 Jul 19;13(7):e0201061. doi: 10.1371/journal.pone.0201061. eCollection 2018.
The interruption of oral anticoagulation therapy (OAC) after CA of atrial fibrillation (AF) is controversial. The purpose of this study was to evaluate the relationship between successful long-term outcomes of catheter resection and SR maintenance and ischemic stroke risk in Korea. We studied 1,548 consecutive patients who were followed up for more than 2 years after CA of AF. We investigated the incidence of ischemic stroke during long-term follow-up. Compared to the AF recurrence group (n = 619), the sinus rhythm (SR) maintenance group (n = 929) had more paroxysmal AF (74.6% versus 44.4%, p<0.001), smaller LA size (39.9±5.7mm versus 42.3±6.0mm, p<0.001), and younger age (54.2±10.9 years versus 56.4±10.6 years, p<0.001). However, CHA2DS2-VASc scores were not significantly different between the two groups (0.9 vs. 1.1, p = 0.053). The overall incidence of ischemic stroke during the mean follow-up period of 54 months after CA was 0.6%, and was significantly lower in the SR group than the AF recurrence group (0.3% vs. 1.1%, log-rank test p<0.001). However, in sub-analysis in the SR group, the rate of ischemic stroke was significantly increasing in patients with a CHA2DS2-VASc score ≥ 4 compared to those with a CHA2DS2-VASc score < 4 (4.3% vs. 0.2%, log-rank test p<0.001). In conclusion, this long-term follow-up data in patients with AF who underwent successful CA showed that SR maintenance was correlated with a lower rate of ischemic stroke in Korea. However, it was only observed in patients with CHA2DS2-VASc score ≤3.
房颤导管消融（CA）后中断口服抗凝治疗（OAC）存在争议。本研究旨在评估导管消融后成功维持窦性心律（SR）与 SR 维持和缺血性卒中风险之间的关系，并在韩国人群中进行研究。我们研究了 1548 例连续房颤患者，这些患者在 CA 后随访时间超过 2 年。我们调查了长期随访期间缺血性卒中的发生率。与房颤复发组（n = 619）相比，窦性心律维持组（n = 929）阵发性房颤更多（74.6% vs. 44.4%，p<0.001），左心房（LA）更小（39.9±5.7mm vs. 42.3±6.0mm，p<0.001），年龄更小（54.2±10.9 岁 vs. 56.4±10.6 岁，p<0.001）。然而，两组 CHA2DS2-VASc 评分无显著差异（0.9 vs. 1.1，p = 0.053）。CA 后平均 54 个月的随访期间，总体缺血性卒中发生率为 0.6%，SR 组明显低于房颤复发组（0.3% vs. 1.1%，log-rank 检验 p<0.001）。然而，在 SR 组的亚组分析中，CHA2DS2-VASc 评分≥4 分的患者缺血性卒中发生率明显高于 CHA2DS2-VASc 评分<4 分的患者（4.3% vs. 0.2%，log-rank 检验 p<0.001）。总之，这项在接受成功 CA 的房颤患者中进行的长期随访数据表明，在韩国，SR 维持与缺血性卒中发生率降低相关。然而，这仅在 CHA2DS2-VASc 评分≤3 的患者中观察到。
