Fujino Tadashi, Yuzawa Hitomi, Kinoshita Toshio, Koike Hideki, Shinohara Masaya, Akitsu Katsuya, Yao Shintaro, Yano Kensuke, Suzuki Takeya, Yamada Midori, Ikeda Takanori
Department of Cardiovascular Medicine, Toho University Graduate School of Medicine.
Department of Adult Nursing, Toho University Faculty of Nursing.
Int Heart J. 2020 Jan 31;61(1):21-28. doi: 10.1536/ihj.19-226. Epub 2020 Jan 17.
Catheter ablation is currently an established treatment for symptomatic paroxysmal atrial fibrillation (AF). We focused on elderly patients with a high prevalence of AF and attempted to identify the clinical factors associated with unsuccessful ablation outcomes.Among 735 consecutive patients who underwent AF ablation procedures, 108 (14.7%, 66 men) aged ≥ 75 years were included. Of them, 80 had paroxysmal AF, and the remaining 28 non-paroxysmal AF. All patients underwent pulmonary vein (PV) isolation and occasionally additional ablation. When AF recurred, redo ablation procedures were performed if the patient so desired.The mean number of ablation procedures was 1.1 ± 0.4 times per patient. During a mean follow-up of 38.7 ± 21.7 months, sinus rhythm was maintained in 100 patients (92.6%) without any antiarrhythmic drugs, but not in the remaining 8 (7.4%). Left atrial diameter (LAD, P < 0.001), left ventricular (LV) systolic diameter (P < 0.001), LV diastolic diameter (P = 0.001), non-PV AF foci (P = 0.036), and diabetes (P = 0.045) were associated with unsuccessful ablation procedures. Multivariate logistic regression analysis revealed a large LAD and non-PV AF foci were significant independent predictors of AF recurrences, with odds ratios of 0.76 (P = 0.019) and 0.04 (P = 0.023), respectively. In a total of 124 procedures, one major (0.8%) and 11 minor (8.9%) complications occurred.In elderly AF patients, catheter ablation of AF is effective and safe. Non-PV AF foci and a large LAD were independent clinical predictors of unsuccessful AF ablation outcomes.
导管消融术目前是有症状的阵发性心房颤动（AF）的既定治疗方法。我们关注AF患病率高的老年患者，并试图确定与消融结果不成功相关的临床因素。在735例连续接受AF消融手术的患者中，纳入了108例年龄≥75岁的患者（14.7%，66例男性）。其中，80例为阵发性AF，其余28例为非阵发性AF。所有患者均接受了肺静脉（PV）隔离，偶尔还进行了额外的消融。当AF复发时，如果患者有意愿，可进行再次消融手术。每位患者的平均消融手术次数为1.1±0.4次。在平均38.7±21.7个月的随访期间，100例患者（92.6%）在未使用任何抗心律失常药物的情况下维持了窦性心律，而其余8例（7.4%）则未维持。左心房直径（LAD，P<0.001）、左心室（LV）收缩直径（P<0.001）、LV舒张直径（P=0.001）、非PV AF病灶（P=0.036）和糖尿病（P=0.045）与消融手术不成功相关。多因素逻辑回归分析显示，大LAD和非PV AF病灶是AF复发的重要独立预测因素，比值比分别为0.76（P=0.019）和0.04（P=0.023）。在总共124例手术中，发生了1例严重并发症（0.8%）和11例轻微并发症（8.9%）。在老年AF患者中，AF导管消融术是有效且安全的。非PV AF病灶和大LAD是AF消融结果不成功的独立临床预测因素。
