在心房颤动中，首次消融与再次消融的安全性和患者报告结局：来自德国消融登记处的见解。
Safety and patient-reported outcomes in index ablation versus repeat ablation in atrial fibrillation: insights from the German Ablation Registry.
机构信息
Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
Department of Cardiology, Angiology and Pneumology, Coburg Hospital, Coburg, Germany.
出版信息
Clin Res Cardiol. 2021 Jun;110(6):841-850. doi: 10.1007/s00392-020-01763-1. Epub 2020 Oct 28.
BACKGROUND
Pulmonary vein isolation is an established strategy for catheter ablation of atrial fibrillation (AF). However, in a significant number of patients, a repeat procedure is mandatory due to arrhythmia recurrence. In this study, we report safety data and procedural details of patients undergoing index ablation versus repeat ablation in a registry-based real-life setting.
METHODS
Patients from the German Ablation Registry, a prospective, multicentre registry of patients undergoing ablation between January 2007 and January 2010 were included.
RESULTS
A total of 4155 patients were enrolled in the study. Group I (index ablation) consisted of 3377/4155 (82.1%) and group II (repeat ablation) of 738/4155 (17.9%). Patients in group I had a significantly higher ratio of paroxysmal AF (69.3% vs 61.9%, p < 0.001) and significantly less persistent AF (30.7% vs 38.1%, p < 0.001). The repeat group showed significantly lower mean RF application duration (2580 s. vs 1960, p < 0.001), less fluoroscopy time (29 min. vs. 27 min., p < 0.001), less mean dose area product (DAP) (3744 cGy × cm vs 3325 cGy × cm, p = 0.001), and shorter study duration (181.2 min. vs 163.6 min., p < 0.001). No statistical difference between the groups was found in terms of mortality (0.3% vs 0.1%, p = 0.39), MACE (0.4% vs 0.3%, p = 0.58), MACCE (0.8% vs 0.6%, p = 0.47), composite safety endpoint (1.5% vs 1.4%, p = 0.76), and arrhythmia recurrence (43.8% vs 41.9%, p = 0.37) during 1-year follow-up. Both groups reported to have improved or no symptoms (80.4% vs 77.8%, p = 0.13).
CONCLUSION
Repeat catheter ablation is safe and provides a symptomatic relief comparable to index ablation. Repeat procedures are significantly shorter and use less fluoroscopy.
背景
肺静脉隔离是导管消融治疗心房颤动（房颤）的一种既定策略。然而，在相当数量的患者中，由于心律失常复发，需要进行重复手术。在本研究中，我们报告了在基于注册的真实环境中进行索引消融与重复消融的患者的安全性数据和手术细节。
方法
该研究纳入了 2007 年 1 月至 2010 年 1 月期间在德国消融注册中心接受消融治疗的患者前瞻性、多中心注册研究中的患者。
结果
共纳入 4155 例患者。第 I 组（索引消融）包括 3377/4155（82.1%），第 II 组（重复消融）包括 738/4155（17.9%）。第 I 组患者阵发性房颤的比例明显较高（69.3% vs 61.9%，p<0.001），持续性房颤的比例明显较低（30.7% vs 38.1%，p<0.001）。重复组的平均射频应用时间明显较短（2580s 与 1960s，p<0.001），透视时间明显较短（29min 与 27min，p<0.001），平均剂量面积乘积（DAP）明显较低（3744cGy×cm 与 3325cGy×cm，p=0.001），研究时间明显较短（181.2min 与 163.6min，p<0.001）。两组在死亡率（0.3%与 0.1%，p=0.39）、MACE（0.4%与 0.3%，p=0.58）、MACCE（0.8%与 0.6%，p=0.47）、复合安全性终点（1.5%与 1.4%，p=0.76）和 1 年随访期间心律失常复发（43.8%与 41.9%，p=0.37）方面无统计学差异。两组均报告症状改善或无改善（80.4%与 77.8%，p=0.13）。
结论
重复导管消融是安全的，提供与索引消融相当的症状缓解。重复手术明显更短，透视时间更短。
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