Kawai Shunsuke, Mukai Yasushi, Inoue Shujiro, Yakabe Daisuke, Nagaoka Kazuhiro, Sakamoto Kazuo, Takase Susumu, Chishaki Akiko, Tsutsui Hiroyuki
Department of Cardiovascular Medicine Graduate School of Medical Sciences Kyushu University Fukuoka Japan.
Department of Health Sciences Graduate School of Medical Sciences Kyushu University Fukuoka Japan.
J Arrhythm. 2019 Jan 18;35(2):223-229. doi: 10.1002/joa3.12150. eCollection 2019 Apr.
Induction test of atrial fibrillation (AF) is one of endpoint measures in catheter ablation (CA). However, its predictive value in long-term outcome remains controversial.
Ninety-eight patients (61 years, 77 males) with persistent AF who underwent pulmonary vein antrum isolation-based CA were retrospectively analyzed. We determined whether inducibility of AF/atrial tachyarrhythmias (AT) by atrial burst pacing at the end of CA and other characteristics were associated with the recurrence of AF/AT. Atrial burst pacing was performed with 30-beat from the coronary sinus; increasing from 240 to 320 ppm. Inducibility was defined as AF/AT lasting ≥5 minutes following atrial burst pacing.
AF/AT was induced in 50 patients (51%). During 1 year of follow-up, 71 patients (72.4%) had no recurrence of AF/AT. A logistic regression analysis showed that female gender (OR 3.8; = 0.02), multiple sessions (OR 3.5; = 0.02), and early recurrence of AF/AT (OR 5.3; = 0.004) were associated with clinical recurrence. AF/AT Inducibility was not associated with clinical recurrence ( = 0.65). A subanalysis in patients with enlarged LA (LA diameter ≥45 mm, n = 40) showed that AF/AT inducibility was associated with recurrence (OR 8.1; = 0.04). The positive and negative predictive values of AF/AT inducibility for AF/AT recurrence were 41 and 89%, respectively. Negative predictive value was increased to 92.3% when the inducibility was defined as AF/AT of ≥30 seconds following atrial burst pacing.
AF/AT inducibility cannot predict long-term clinical recurrence in patients with persistent AF. However, it may have a prognostic value especially in patients with enlarged LA.
心房颤动（AF）诱发试验是导管消融（CA）的终点指标之一。然而，其对长期预后的预测价值仍存在争议。
回顾性分析98例（61岁，77例男性）接受基于肺静脉前庭隔离的CA治疗的持续性AF患者。我们确定CA结束时心房猝发刺激诱发AF/房性快速心律失常（AT）的情况以及其他特征是否与AF/AT复发相关。心房猝发刺激从冠状窦以30次搏动进行；频率从240 ppm增加到320 ppm。诱发性定义为心房猝发刺激后AF/AT持续≥5分钟。
50例患者（51%）诱发出AF/AT。在1年的随访期间，71例患者（72.4%）未出现AF/AT复发。逻辑回归分析显示，女性（比值比3.8；P = 0.02）、多次手术（比值比3.5；P = 0.02）以及AF/AT早期复发（比值比5.3；P = 0.004）与临床复发相关。AF/AT诱发性与临床复发无关（P = 0.65）。对左心房扩大（左心房直径≥45 mm，n = 40）患者的亚分析显示，AF/AT诱发性与复发相关（比值比8.1；P = 0.04）。AF/AT诱发性对AF/AT复发的阳性和阴性预测值分别为41%和89%。当诱发性定义为心房猝发刺激后AF/AT≥30秒时，阴性预测值增加到92.3%。
AF/AT诱发性不能预测持续性AF患者的长期临床复发。然而，它可能具有预后价值，尤其是在左心房扩大的患者中。
