Wang Hao, Wang Cheng, Chen Jindong, Zhao Liang, Pan Xin
Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
J Interv Card Electrophysiol. 2019 Apr;54(3):217-224. doi: 10.1007/s10840-018-0505-1. Epub 2019 Jan 3.
This study aimed to evaluate efficacy, safety, and long-term outcome of radiofrequency catheter ablation (RFCA) for atrial tachyarrhythmia (ATa) in patients with atrial septal defect (ASD).
Seventy-five ASD patients with ATa (52% atrial fibrillation, AF) were enrolled. Electrophysiological study and RFCA were performed, with endpoints of index and multiple procedures as follows: (a) atrial tachycardia/atrial flutter (AT/AFL), absence of inducibility of any atrial arrhythmia and (b) AF, circumferential pulmonary vein ablation (CPVA, paroxysmal AF), bidirectional block of lines, and disappearance of complex fractionated atrial electrograms (persistent and long-standing persistent (LSP)-AF).
Cumulative success rate at 1-year follow-up was 79.9% and dropped to 59.0% at a median follow-up of 63 months (range, 14-114 months) for multiple procedures (mean 1.6 ± 0.7 [1-3]). Freedom from ATa after multiple procedures was achieved in 75% patients with AT/AFL and 43.6% patients with AF (P = 0.006 for comparison). In multivariate analysis, older age at ASD correction (HR, 1.033 [95% CI, 1.008-1.059]; P = 0.01), ASD diameter before correction (HR, 1.054 [95% CI, 1.006-1.105]; P = 0.027), and first-diagnosed ATa type (AF; HR, 2.25 [95% CI, 1.03-4.92]; P = 0.042) were significant independent predictors of ATa recurrence. Patients with more risk factors had higher risk of ATa recurrence.
The long-term outcome of RFCA for ATa outcome was favorable for AT/AFL while mediocre for AF. ATa recurrence was more common in patients with older age at ASD correction, larger ASD diameter before correction, and first-diagnosed AF. Patients with more risk factors had higher ATa recurrence risk.
本研究旨在评估射频导管消融术（RFCA）治疗房间隔缺损（ASD）患者房性快速心律失常（ATa）的疗效、安全性及长期预后。
纳入75例患有ATa的ASD患者（52%为心房颤动，AF）。进行了电生理研究和RFCA，单次及多次手术的终点如下：（a）房性心动过速/心房扑动（AT/AFL），任何房性心律失常均不能诱发；（b）AF，环肺静脉消融（CPVA，阵发性AF），线性双向阻滞，以及碎裂心房电图消失（持续性和长期持续性（LSP）-AF）。
单次手术1年随访时的累积成功率为79.9%，多次手术（平均1.6±0.7[1 - 3]次）在中位随访63个月（范围14 - 114个月）时降至59.0%。多次手术后，75%的AT/AFL患者和43.6%的AF患者实现了无ATa（比较P = 0.006）。多因素分析显示，ASD矫正时年龄较大（HR，1.033[95%CI，1.008 - 1.059]；P = 0.01）、矫正前ASD直径（HR，1.054[95%CI，1.006 - 1.105]；P = 0.027）以及首次诊断的ATa类型（AF；HR，2.25[95%CI，1.03 - 4.92]；P = 0.042）是ATa复发的显著独立预测因素。危险因素越多的患者ATa复发风险越高。
RFCA治疗ATa的长期预后对于AT/AFL较好，而对于AF一般。在ASD矫正时年龄较大、矫正前ASD直径较大以及首次诊断为AF的患者中，ATa复发更为常见。危险因素越多的患者ATa复发风险越高。
