心房颤动消融术后复发的房性快速性心律失常与患者长期预后的关系。
Association between early recurrences of atrial tachyarrhythmias and long-term outcomes in patients after repeat atrial fibrillation ablation.
机构信息
Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA.
出版信息
J Interv Card Electrophysiol. 2022 Aug;64(2):323-331. doi: 10.1007/s10840-021-00987-z. Epub 2021 Apr 7.
PURPOSE
Early recurrence of atrial tachyarrhythmia (ER) is predictive of late recurrence of atrial tachyarrhythmia (LR) after first-time atrial fibrillation (AF) ablation, but the association in patients undergoing repeat AF ablation is unknown. We aim to determine the incidence and prognostic significance of ER after repeat ablation.
METHODS
A total of 259 consecutive patients (mean age 64 years, 75.3% male) undergoing repeat AF ablation with complete follow-up data were included at a single institution from 2010 to 2015. ER and LR were defined as atrial tachyarrhythmia (AF, atrial flutter or atrial tachycardia) > 30 s within the 3-month blanking period (BP) and after the 3-month BP, respectively.
RESULTS
ER occurred in 79/259 (30.5%), and LR occurred in 138/259 (53%) at a median follow-up of 1221 (IQR: 523-1712) days. Four-year freedom from LR was 22% and 56% in patients with and without ER, respectively (p < 0.001). After multivariate adjustment, ER was strongly associated with LR, cardioversion post BP, and repeat ablation, but not associated with hospitalization. Compared to those with no ER, there was a higher risk of LR when ER occurred within the first month of the BP [month 1: hazard ratio (HR) 2.32, confidence interval (CI) 1.57-3.74, p < 0.001; month 2: HR 2.01, CI 1.13-3.83, p = 0.02; month 3: HR 1.46, CI 0.5-3.36, p = 0.37], however the prediction of LR based on timing within the BP was poor (area under curve 0.64).
CONCLUSION
Following repeat AF ablation, ER is strongly associated with LR, cardioversion post BP, and repeat ablation.
目的
心房快速性心律失常（ER）的早期复发可预测首次心房颤动（AF）消融后心房快速性心律失常（LR）的晚期复发，但在接受重复 AF 消融的患者中，这种关联尚不清楚。我们旨在确定重复消融后 ER 的发生率和预后意义。
方法
在 2010 年至 2015 年期间，在一家机构中，对 259 例连续接受重复 AF 消融治疗且具有完整随访数据的患者进行了研究。ER 和 LR 定义为空白期（BP）内和 BP 后 3 个月内> 30 s 的房性快速性心律失常（AF、心房扑动或房性心动过速）。
结果
259 例患者中，79 例（30.5%）发生 ER，138 例（53%）发生 LR，中位随访时间为 1221（IQR：523-1712）天。无 ER 患者的 4 年 LR 无复发率为 22%，有 ER 患者为 56%（p<0.001）。多变量调整后，ER 与 LR、BP 后电复律和重复消融强烈相关，但与住院无关。与无 ER 患者相比，BP 内第一个月发生 ER 时，LR 的风险更高[第 1 个月：风险比（HR）2.32，置信区间（CI）1.57-3.74，p<0.001；第 2 个月：HR 2.01，CI 1.13-3.83，p=0.02；第 3 个月：HR 1.46，CI 0.5-3.36，p=0.37]，但基于 BP 内时间预测 LR 的准确性较差（曲线下面积 0.64）。
结论
在重复 AF 消融后，ER 与 LR、BP 后电复律和重复消融密切相关。
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