Kim Yun Gi, Boo Ki Yung, Choi Jong-Il, Choi Yun Young, Choi Ha Young, Roh Seung-Young, Shim Jaemin, Kim Jin Seok, Kim Young-Hoon
Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea.
Division of Cardiology, Korea University College of Medicine and Korea University Medicine Anam Hospital, Seoul, Republic of Korea.
JACC Clin Electrophysiol. 2021 Mar;7(3):343-351. doi: 10.1016/j.jacep.2020.09.029. Epub 2021 Jan 27.
This study aimed to compare the risk of late recurrence in patients with and without early recurrence.
Early recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) after radiofrequency catheter ablation (RFCA) in AF patients is known to be a transient phenomenon. The theoretical basis of the blanking period is based on such observations. However, the clinical implications of early recurrence need further validation.
Consecutive RFCA cases in a tertiary hospital were analyzed. Early recurrence was defined as any AT or AF event occurring within 90-days post-RFCA. Early recurrence as AT and AF were also analyzed separately.
A total of 3,120 patients underwent RFCA. Early recurrence occurred in 751 patients (24.1%). Patients who experienced early recurrence had a larger left atrium, worse hemodynamics in the left atrial appendage, and a higher prevalence of nonparoxysmal AF and heart failure. Among patients who experienced early recurrence, 69.6% of patients eventually had late recurrence. Early recurrence was associated with a 4.3- and 3.6-fold increase in the risk of late recurrence after single and multiple procedures, respectively. After multivariate adjustment, early recurrence was an independent risk factor for late recurrence with 3.6- and 2.8-fold increase in the risk of late recurrence after single and multiple procedures, respectively. Early recurrence AT had a lower risk of late recurrence compared with early recurrence AF.
Early recurrence was a reliable predictor for late recurrence. The clinical significance of the blanking period in the current guidelines may need to be revisited.
本研究旨在比较有早期复发和无早期复发患者的晚期复发风险。
房颤患者射频导管消融（RFCA）术后房颤（AF）或房性心动过速（AT）的早期复发是一种短暂现象。空白期的理论基础即基于此类观察结果。然而，早期复发的临床意义尚需进一步验证。
分析一家三级医院的连续RFCA病例。早期复发定义为RFCA术后90天内发生的任何AT或AF事件。早期复发为AT和AF的情况也分别进行了分析。
共有3120例患者接受了RFCA。751例患者（24.1%）发生早期复发。发生早期复发的患者左心房更大，左心耳血流动力学更差，非阵发性房颤和心力衰竭的患病率更高。在发生早期复发的患者中，69.6%的患者最终出现晚期复发。单次和多次手术后，早期复发分别使晚期复发风险增加4.3倍和3.6倍。多因素调整后，早期复发是晚期复发的独立危险因素，单次和多次手术后晚期复发风险分别增加3.6倍和2.8倍。早期复发AT的晚期复发风险低于早期复发AF。
早期复发是晚期复发的可靠预测指标。现行指南中空白期的临床意义可能需要重新审视。
