Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Email:
Cardiovasc J Afr. 2022;33(3):112-116. doi: 10.5830/CVJA-2021-044. Epub 2021 Oct 15.
This study aimed to assess the relationship between the cardiac rhythm response to ibutilide infusion after pulmonary vein isolation and the recurrence of long-term atrial arrhythmias.
One hundred and thirty-eight patients with non-paroxysmal atrial fibrillation who had had their first catheter ablation were retrospectively included. All patients whose atrial fibrillation did not terminate after pulmonary vein isolation were administered intravenous ibutilide (1.0 mg). Those with termination of atrial fibrillation after ibutilide administration were defined as responders ( = 86); those without termination of atrial fibrillation, as non-responders ( = 52). The primary endpoint was any documented recurrence of atrial arrhythmia lasting more than 30 seconds after the initial catheter ablation.
Conversion of atrial fibrillation to sinus rhythm, directly or via atrial flutter, with ibutilide administration was achieved in 62.3% of patients. A longer duration of atrial fibrillation was associated with failed termination of atrial fibrillation (odds ratio 1.009, 95% confidence interval 1.002-1.017, = 0.011). During a median follow-up period of 610 days (interquartile range 475-1 106) post ablation, non-responders ( = 24, 46.2%) had a higher recurrence rate of atrial arrhythmia than the responders ( = 26, 30.2%; log-rank, = 0.011) after the initial catheter ablation. Multivariate Cox regression analysis revealed that non-responders (hazard ratio 1.994, 95% confidence interval 1.117-3.561, = 0.020) was significantly correlated with recurrence of atrial arrhythmias.
In patients whose atrial fibrillation persisted after pulmonary vein isolation, the response to ibutilide administration could predict the recurrence of atrial arrhythmias after catheter ablation, which may be useful for risk stratification for recurrence of atrial fibrillation and individualised management of atrial fibrillation.
本研究旨在评估肺静脉隔离后伊布利特输注引起的心脏节律反应与长期房性心律失常复发之间的关系。
回顾性纳入 138 例首次导管消融的非阵发性心房颤动患者。所有肺静脉隔离后心房颤动未终止的患者均给予静脉注射伊布利特（1.0mg）。伊布利特给药后心房颤动终止的患者定义为应答者（n=86）；未终止的患者定义为无应答者（n=52）。主要终点是初始导管消融后 30 秒以上的任何有记录的房性心律失常复发。
伊布利特给药后，62.3%的患者直接或通过心房扑动转为窦性心律。心房颤动持续时间较长与心房颤动终止失败相关（比值比 1.009，95%置信区间 1.002-1.017，P=0.011）。在消融后中位随访 610 天（四分位距 475-1106）期间，无应答者（n=24，46.2%）比应答者（n=26，30.2%；log-rank，P=0.011）的心房颤动复发率更高。多变量 Cox 回归分析显示，无应答者（风险比 1.994，95%置信区间 1.117-3.561，P=0.020）与心房颤动复发显著相关。
在肺静脉隔离后心房颤动持续存在的患者中，伊布利特给药的反应可预测导管消融后房性心律失常的复发，这可能有助于心房颤动复发的风险分层和个体化心房颤动的管理。
