Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; The University of Newcastle, Newcastle, NSW, Australia.
Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; The University of Newcastle, Newcastle, NSW, Australia.
Heart Lung Circ. 2021 Aug;30(8):1166-1173. doi: 10.1016/j.hlc.2021.01.013. Epub 2021 Mar 13.
Different endpoint criteria, different durations of follow-up and the completeness of follow-up can dramatically affect the perceived benefits of atrial fibrillation (AF) ablation.
We defined three endpoints for recurrence of AF post ablation in a cohort of 200 patients with symptomatic AF, refractory to antiarrhythmic drugs (AADs). A 'Strict Endpoint' where patients were considered to have a recurrence with any symptomatic or documented recurrence for ≥30 seconds with no blanking period, and off their AADs, a 'Liberal Endpoint' where only documented recurrences after the blanking period, either on or off AADs were counted, and a 'Patient-defined Outcome endpoint' which was the same as the Liberal endpoint but allowed for up to two recurrences and one repeat ablation or DCCV during follow-up. We also surveyed 50 patients on the waiting list for an AF ablation and asked them key questions regarding what they would consider to be a successful result for them.
Freedom from recurrence of atrial tachyarrhythmias (AT) at 5 years was 62% for the Strict Endpoint, 73% for the Liberal Endpoint, and 80% for the Patient-defined Outcome endpoint (p<0.001). Of the 50 patients surveyed awaiting AF ablation, 70% said they would still consider the procedure a success if it required one repeat ablation or one DCCV (p=0.004), and 76% would be accepting of one or two recurrences during follow-up (p<0.001).
In this study, the majority of patients still considered AF ablation a successful treatment if they had up to two recurrences of AF, one repeat procedure or one DCCV. Furthermore, a 'Patient-defined' definition of success lead to significantly different results in this AF ablation cohort when compared to conventionally used/guideline directed measures of success.
不同的终点标准、不同的随访时间和随访的完整性可以显著影响对心房颤动（AF）消融的获益的认知。
我们在 200 例对抗心律失常药物（AAD）治疗无效的症状性 AF 患者队列中定义了消融后 AF 复发的三个终点。“严格终点”定义为患者在无空白期的情况下出现任何有症状或记录的≥30 秒的复发，且停用 AAD 时即被认为复发；“宽松终点”仅记录空白期后的复发，无论是否使用 AAD；“患者定义的结局终点”与宽松终点相同，但允许在随访期间最多出现两次复发和一次重复消融或直流电复律（DCCV）。我们还对等待 AF 消融的 50 名患者进行了调查，询问他们关于认为对自己成功的关键问题。
严格终点的 5 年无房性心动过速（AT）复发率为 62%，宽松终点为 73%，患者定义的结局终点为 80%（p<0.001）。在等待 AF 消融的 50 名患者中，70%表示如果需要重复一次消融或一次 DCCV，他们仍会认为该手术成功（p=0.004），76%会接受随访期间出现一次或两次复发（p<0.001）。
在这项研究中，如果患者有两次 AF 复发、一次重复手术或一次 DCCV，大多数患者仍会认为 AF 消融是一种成功的治疗方法。此外，与传统使用/指南指导的成功衡量标准相比，“患者定义”的成功标准在该 AF 消融队列中产生了显著不同的结果。
