Faculty of Medicine, Department of Cardiology, Hacettepe University, Sıhhıye,Ankara, Turkey.
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
Europace. 2019 Nov 1;21(11):1653-1662. doi: 10.1093/europace/euz232.
Pulmonary vein isolation (PVI) alone in persistent atrial fibrillation (AF) is not as successful as in paroxysmal AF, and recent data indicate the key role of non-PV triggers. We aimed to assess the long-term safety and efficacy of left atrial appendage isolation (LAAi) as an adjunct to PVI using cryoballoon (CB) in persistent AF.
We compared 144 persistent AF patients (59 ± 10 years, 51% females) who underwent PVI combined with LAAi with a propensity-score matched cohort of 138 persistent AF patients (59 ± 6 years, 52% female) in whom PVI-only was performed. Baseline and follow-up data including electrocardiography (ECG), 24-h Holter ECG's, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a mean of 30.5 ± 5.6 months follow-up, 85 (61.6%) patients in the PVI-only group and 109 (75.7%) patients in the PVI+LAAi group were free of ATa after the index procedure (P = 0.008). Ischaemic stroke/transient ischaemic attack was detected in 4 (2.9%) patients in PVI-only group and in 5 (3.5%) patients in the PVI+LAAi group (P = 0.784). Cox regression analysis revealed that the PVI-only strategy was found as a significant predictor for recurrence (hazard ratio 3.01, 95% confidence interval 1.81-5.03; P < 0.001).
Our findings indicated that CB-based LAAi+PVI was associated with a favourable efficacy compared to PVI-only strategy in patients with persistent AF. Although ischaemic event rates were similar between the groups, rigorous adherence to anticoagulation regime is paramount in order to prevent thrombo-embolic complications.
肺静脉隔离（PVI）单独用于持续性心房颤动（AF）的成功率不如阵发性 AF，最近的数据表明非 PV 触发因素起着关键作用。我们旨在评估使用冷冻球囊（CB）对持续性 AF 患者进行左心耳隔离（LAAi）作为 PVI 辅助治疗的长期安全性和有效性。
我们比较了 144 例接受 PVI 联合 LAAi 的持续性 AF 患者（59±10 岁，51%为女性）和 138 例接受单纯 PVI 的持续性 AF 患者（59±6 岁，52%为女性）的队列。所有患者均记录了基线和随访数据，包括心电图（ECG）、24 小时动态心电图和超声心动图。房性快速性心律失常（ATa）复发定义为在 3 个月的空白期后检测到 AF、心房扑动或房性心动过速（≥30 秒）。在平均 30.5±5.6 个月的随访中，PVI 组有 85 例（61.6%）和 PVI+LAAi 组有 109 例（75.7%）患者在指数手术后无 ATa（P=0.008）。PVI 组有 4 例（2.9%）和 PVI+LAAi 组有 5 例（3.5%）患者检测到缺血性卒中和短暂性脑缺血发作（P=0.784）。Cox 回归分析显示，PVI 策略是复发的显著预测因素（危险比 3.01，95%置信区间 1.81-5.03；P<0.001）。
我们的研究结果表明，与单纯 PVI 策略相比，基于 CB 的 LAAi+PVI 治疗持续性 AF 患者的疗效更好。尽管两组的缺血性事件发生率相似，但严格遵循抗凝治疗方案至关重要，以预防血栓栓塞并发症。
