Yu Hee Tae, Kim In-Soo, Kim Tae-Hoon, Uhm Jae-Sun, Kim Jong-Youn, Joung Boyoung, Lee Moon-Hyoung, Pak Hui-Nam
Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea.
J Cardiovasc Electrophysiol. 2020 Feb;31(2):457-464. doi: 10.1111/jce.14345. Epub 2020 Jan 15.
Longer atrial fibrillation (AF) durations have higher recurrence rates after rhythm control. However, there is limited data on the effect of the AF duration on recurrence after atrial fibrillation catheter ablation (AFCA). In the present study, we investigated the rhythm outcome of AFCA according to the AF duration based on the first electrocardiogram (ECG) diagnosis.
We included 1005 patients with AF (75% male, 59 ± 11 years old) who underwent AFCA and whose first ECG diagnosis time point was evident. The clinical characteristics and rhythm outcomes were compared based on the AF duration (≤3 years, n = 537; >3 years, n = 468) and AF burden (paroxysmal atrial fibrillation [PAF], n = 387; persistent atrial fibrillation [PeAF], n = 618). Longer AF durations were associated with older age (P = .020), larger left atrial size (P = .009) and a higher number of patients with hypertension (P < .001) or PeAF (P < .001). During 24 ± 22 months of follow-up, the postablation clinical recurrence rate was higher in patients with a longer AF duration (logrank P = .002). The AF recurrence rate was significantly higher in PeAF patients with an AF duration >3 years (logrank P = 0.009), but not in subjects with PAF (logrank P = .939). In a multivariate Cox regression analysis, a longer AF duration was significantly associated with a higher clinical recurrence rate after AFCA in PeAF patients (adjusted hazard ratio, 1.06; range, 1.03-0.10; P = 0.001), but not PAF.
Although longer AF duration was associated with higher clinical recurrence rates after AFCA, the rate was significant in patients with PeAF lasting >3 years, but not in PAF patients.
房颤（AF）持续时间越长，节律控制后的复发率越高。然而，关于房颤持续时间对房颤导管消融（AFCA）后复发的影响的数据有限。在本研究中，我们根据首次心电图（ECG）诊断的房颤持续时间，研究了AFCA的节律结果。
我们纳入了1005例接受AFCA且首次心电图诊断时间点明确的房颤患者（75%为男性，年龄59±11岁）。根据房颤持续时间（≤3年，n = 537；>3年，n = 468）和房颤负荷（阵发性房颤[PAF]，n = 387；持续性房颤[PeAF]，n = 618）比较临床特征和节律结果。较长的房颤持续时间与年龄较大（P = 0.020）、左心房较大（P = 0.009）以及高血压患者（P < 0.001）或PeAF患者（P < 0.001）数量较多相关。在24±22个月的随访期间，房颤持续时间较长的患者消融后临床复发率较高（对数秩检验P = 0.002）。房颤持续时间>3年的PeAF患者房颤复发率显著较高（对数秩检验P = 0.009），但PAF患者中则不然（对数秩检验P = 0.939）。在多因素Cox回归分析中，较长的房颤持续时间与PeAF患者AFCA后较高的临床复发率显著相关（调整后风险比，1.06；范围，1.03 - 0.10；P = 0.001），但与PAF患者无关。
虽然较长的房颤持续时间与AFCA后较高的临床复发率相关，但在持续时间>3年的PeAF患者中该比率显著，而在PAF患者中则不然。
