Clinical Pharmacist, Missouri Baptist Medical Center (study institution), St. Louis, Missouri.
Department of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, Missouri.
J Clin Pharm Ther. 2019 Oct;44(5):708-714. doi: 10.1111/jcpt.12846. Epub 2019 May 6.
Current guidelines recommend catheter ablation (CA) for atrial fibrillation (AF) refractory to at least one antiarrhythmic drug (AAD), but do not specify an adequate number of AADs to be trialed prior to considering ablation. The objective of this study was to evaluate the effect of CA success based on the number of AADs failed in patients with paroxysmal or persistent AF.
This retrospective cohort study evaluated patients with paroxysmal or persistent AF who underwent an initial CA at a community hospital. Patients with unknown AAD histories, those who did not achieve acute procedural success, or who were lost to follow-up or death unrelated to thromboembolic stroke within 6 months post-ablation were excluded. Catheter ablation success was defined as freedom from AF. The primary outcome was the incidence of AF or atrial flutter captured on an electrocardiogram or other recording device at 3, 6, 9 and 12 months after the procedure.
Overall, 99 out of 103 patients completed 1 year of follow-up. Of those patients, 34 of 99 (34.3%) experienced AF recurrence within 1-year post-ablation. There was no significant difference among the categories of number of failed AADs and the recurrence of AF within 12 months post-ablation for zero AADs, 1 AADs and ≥2 AADs (41.7%, 31.3% and 40%, respectively; P = 0.658).
The results of this study do not support preferentially performing CA on patients who have failed a certain number of AADs. Results are limited by the nature of the study design and a small sample size. Conclusive results would best be addressed by a prospective randomized trial.
目前的指南建议对至少一种抗心律失常药物（AAD）无效的心房颤动（AF）进行导管消融（CA），但未具体规定在考虑消融之前应尝试多少种 AAD。本研究的目的是评估基于阵发性或持续性 AF 患者失败的 AAD 数量评估 CA 成功的效果。
本回顾性队列研究评估了在社区医院接受初始 CA 的阵发性或持续性 AF 患者。排除了未知 AAD 病史、未达到急性程序成功、或在消融后 6 个月内因血栓栓塞性中风以外的原因失去随访或死亡的患者。导管消融成功定义为 AF 无复发。主要结果是在手术后 3、6、9 和 12 个月通过心电图或其他记录设备捕获的 AF 或心房扑动的发生率。
总体而言，103 名患者中有 99 名完成了 1 年的随访。在这些患者中，99 名中有 34 名（34.3%）在消融后 1 年内出现 AF 复发。在零 AAD、1 AAD 和≥2 AAD 的失败 AAD 数量类别中，12 个月内 AF 复发的发生率没有显著差异（分别为 41.7%、31.3%和 40%；P=0.658）。
本研究的结果不支持优先对已使用一定数量 AAD 失败的患者进行 CA。结果受到研究设计的性质和样本量小的限制。前瞻性随机试验将最好地解决这一问题。
