抗心律失常药物治疗与导管消融治疗长程持续性心房颤动的比较：单中心、倾向性匹配队列研究。
The convergent procedure versus catheter ablation alone in longstanding persistent atrial fibrillation: A single centre, propensity-matched cohort study.
机构信息
Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK; William Harvey Research Institute, Charterhouse Square, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK.
出版信息
Int J Cardiol. 2020 Mar 15;303:49-53. doi: 10.1016/j.ijcard.2019.10.053.
BACKGROUND
Maintenance of sinus rhythm is challenging in patients with longstanding persistent atrial fibrillation (PeAF). Minimally invasive surgical AF ablation may improve outcomes when combined with catheter ablation (the 'convergent' procedure). This study evaluates the safety and efficacy of the convergent procedure versus catheter ablation alone in longstanding PeAF.
METHODS
43 consecutive patients with longstanding PeAF underwent subxiphoid endoscopic ablation of the posterior left atrium followed by catheter ablation from 2013 to 2018. The primary outcome was AF-free survival at 12 months; secondary outcomes included change in EHRA class, echocardiographic data, procedural complications, freedom from anti-arrhythmic drugs (AADs), and long term arrhythmia-free survival. Outcomes were compared with a matched group of 43 patients who underwent catheter ablation alone. Both groups underwent multiple catheter ablations as required. Baseline characteristics were similar between groups.
RESULTS
After 12 months, the convergent procedure was associated with increased AF-free survival on AADs (60.5% versus 25.6%, p = .002) and off AADs (37.2% versus 13.9%, p = .025), versus catheter ablation. Allowing for multiple procedures, after 30.5 ± 13.3 months' follow-up the convergent procedure was associated with increased arrhythmia-free survival on AADs (58.1% versus 30.2%, p = .016) and off AADs (32.5% versus 11.6%, p = .036) versus catheter ablation. There were more complications in the convergent procedure group (11.6% versus 2.3%, p = .2). Multivariate analysis identified only the convergent procedure (OR 3.06 (1.23-7.6), p = .017) as predictive of arrhythmia-free survival long term.
CONCLUSIONS
In longstanding PeAF, the convergent procedure is associated with improved arrhythmia-free survival versus catheter ablation alone. Complication rates are significant but have been shown to depreciate with experience.
背景
对于长期持续性心房颤动（PeAF）患者，维持窦律具有挑战性。微创外科房颤消融术（AF）联合导管消融术（“融合”手术）可能改善结果。本研究评估了融合手术与单独导管消融术治疗长期 PeAF 的安全性和有效性。
方法
2013 年至 2018 年，连续 43 例长期 PeAF 患者接受剑突下心内镜下左心房后壁消融术，然后行导管消融术。主要终点为 12 个月时 AF 无复发生存率；次要终点包括 EHRA 分级变化、超声心动图数据、手术并发症、抗心律失常药物（AAD）无复发率和长期无心律失常生存率。将结果与单独接受导管消融术的 43 例匹配患者进行比较。两组均根据需要进行多次导管消融术。两组患者的基线特征相似。
结果
12 个月时，融合手术与导管消融术相比，AAD （60.5%比 25.6%，p=0.002）和无 AAD（37.2%比 13.9%，p=0.025）时的 AF 无复发生存率更高。考虑到多次手术，在 30.5±13.3 个月的随访后，融合手术与导管消融术相比，AAD（58.1%比 30.2%，p=0.016）和无 AAD（32.5%比 11.6%，p=0.036）时的无心律失常生存率更高。融合手术组并发症更多（11.6%比 2.3%，p=0.2）。多变量分析仅发现融合手术（OR 3.06（1.23-7.6），p=0.017）是长期无心律失常生存率的预测因素。
结论
在长期 PeAF 中，与单独导管消融术相比，融合手术与改善的无心律失常生存率相关。并发症发生率较高，但随着经验的积累，并发症发生率会降低。
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