Jurcevic Ruzica, Angelkov Lazar, Tasic Nebojsa, Tomovic Milosav, Kojic Dejan, Otasevic Petar, Bojic Milovan
Department of Electrophysiology, Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepica 1, 11000 Belgrade, Serbia.
J Clin Med. 2021 Dec 13;10(24):5827. doi: 10.3390/jcm10245827.
This study introduces the pulmonary vein isolation outcome degree (PVIOD) as a new semiquantitative measure for the efficacy of atrial fibrillation (AF) catheter ablation and reports the determination of predictors associated with PVIOD. The median follow-up periods of 117 patients after the first and last ablation were, respectively, 82 (IQR 15) and 72 (IQR 30) months. PVIOD 1 included 32.5% of patients, those with successful single pulmonary vein isolation (PVI); PVIOD 2 included 29.1% of subjects, those with success after multiple procedures; PVIOD 3 comprised 14.5% of patients, those with clinical success; and PVIOD 4 included 23.9% of cases, those with procedural and clinical failure. In the multivariate ordinal logistic regression analysis, PVIOD 1-4 were independently associated with longstanding persistent AF with paroxysmal AF as the referent category (odds ratio (OR), 3.5; 95% confidence interval (95% CI), 1.1-10.7 ( = 0.031)), left atrial (LA) diameter (OR, 1.2; 95% CI, 1.1-1.3 ( = 0.001)) and left ventricular ejection fraction (LVEF) (OR, 0.9; 95% CI, 0.86-1.0 ( = 0.038)). LA size > 41 mm, LVEF ≤ 50% and longstanding persistent AF are strong predictors of AF recurrence. PVIOD 1-4 offer the most exact long-term prognosis of PVI. The purpose of the present article is to expand the quantitative measure of procedural success in the medical and biological fields.
本研究引入肺静脉隔离结局程度（PVIOD）作为心房颤动（AF）导管消融疗效的一种新的半定量指标，并报告与PVIOD相关的预测因素的确定情况。117例患者首次和末次消融后的中位随访期分别为82（四分位间距15）个月和72（四分位间距30）个月。PVIOD 1包括32.5%的患者，即单次肺静脉隔离（PVI）成功的患者；PVIOD 2包括29.1%的受试者，即多次手术后成功的患者；PVIOD 3包括14.5%的患者，即临床成功的患者；PVIOD 4包括23.9%的病例，即手术和临床失败的患者。在多变量有序逻辑回归分析中，以阵发性AF为参照类别，PVIOD 1 - 4与长期持续性AF独立相关（比值比（OR）为3.5；95%置信区间（95%CI）为1.1 - 10.7（P = 0.031））、左心房（LA）直径（OR为1.2；95%CI为1.1 - 1.3（P = 0.001））和左心室射血分数（LVEF）（OR为0.9；95%CI为0.86 - 1.0（P = 0.038））。LA大小>41 mm、LVEF≤50%和长期持续性AF是AF复发的强预测因素。PVIOD 1 - 4提供了PVI最准确的长期预后。本文的目的是扩展医学和生物学领域手术成功度的定量指标。
