心房颤动消融的长期结局
Very long term outcomes of atrial fibrillation ablation.
作者信息
Winkle Roger A, Mead R Hardwin, Engel Gregory, Salcedo Jonathan, Brodt Chad, Barberini Patricia, Lebsack Cynthia, Kong Melissa H, Kalantarian Shadi, Patrawala Rob A
机构信息
Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California.
Sutter Health, Palo Alto Medical Foundation and Silicon Valley Cardiology, East Palo Alto, California; Sequoia Hospital, Redwood City, California.
出版信息
Heart Rhythm. 2023 May;20(5):680-688. doi: 10.1016/j.hrthm.2023.02.002. Epub 2023 Feb 9.
BACKGROUND
Little is known about the very long term durability of atrial fibrillation (AF) ablation.
OBJECTIVE
The purpose of this study was to evaluate very long term AF ablation outcomes.
METHODS
We followed 5200 patients undergoing 7145 ablation procedures. We evaluated outcomes after single and multiple ablation procedures for paroxysmal (PAF; 33.6%), persistent (PeAF; 56.4%), and long-standing (LsAF; 9.9%) AF. We compared 3 ablation eras by initial ablation catheter: early (101 patients) using solid big tip (SBT) catheters (October 2003 to December 2005), intermediate (2143 patients) using open irrigated tip (OIT) catheters (December 2005 to August 2016), and contemporary (2956 patients) using contact force (CF) catheters (March 2014 to December 2021).
RESULTS
AF freedom at 5, 10, and 15 years was as follows: initial ablation: PAF 67.8%, 56.3%, 47.6%; PeAF 46.6%, 35.6%, 26.5%; and LsAF 30.4%, 18.0%, 3.4%; final ablation: PAF 80.3%, 72.6%, 62.5%; PeAF 60.1%, 50.2%, 42.5%; and LsAF 43.4%, 32.0%, 20.6%. For PAF and PeAF, CF ablation procedures were better than OIT ablation procedures (P < .0001) and both were better than SBT ablation procedures (P < .001). LsAF had no outcome improvement over the eras. The 8-year success rate after final ablation for CF, OIT, and SBT catheter eras was as follows: PAF 79.1%, 71.8%, 60.0%; PeAF 55.9%, 50.7%, 38.0%; and LsAF 42.7%, 36.2%, 31.8%. Highest AF recurrence was in the first 2 years, with a 2- to 15-year recurrence of 2%/yr. Success predictors after initial and final ablation procedures were younger age, smaller left atrium, shorter AF duration, male sex, less persistent AF, lower CHADS-VASc score, fewer drugs failed, and more recent catheter era.
CONCLUSION
After year 2, there is 2%/yr recurrence rate for all AF types. Ablation success is best in the CF catheter era, intermediate in the OIT era, and worst in the SBT era. Over the ablation eras, outcomes improved for PAF and PeAF but not for LsAF. We should follow patients indefinitely after ablation. We need an understanding of how to better ablate more persistent AF.
背景
关于心房颤动（AF）消融术的长期耐久性，人们了解甚少。
目的
本研究旨在评估AF消融术的长期疗效。
方法
我们对接受7145次消融手术的5200例患者进行了随访。我们评估了阵发性房颤（PAF；33.6%）、持续性房颤（PeAF；56.4%）和长期持续性房颤（LsAF；9.9%）单次及多次消融术后的疗效。我们根据初次消融导管将3个消融时代进行了比较：早期（101例患者）使用实心大尖端（SBT）导管（2003年10月至2005年12月），中期（2143例患者）使用开放式灌注尖端（OIT）导管（2005年12月至2016年8月），以及当代（2956例患者）使用接触力（CF）导管（2014年3月至2021年12月）。
结果
5年、10年和15年时的房颤无复发率如下：初次消融：PAF为67.8%、56.3%、47.6%；PeAF为46.6%、35.6%、26.5%；LsAF为30.4%、18.0%、3.4%；最终消融：PAF为80.3%、72.6%、62.5%；PeAF为60.1%、50.2%、42.5%；LsAF为43.4%、32.0%、20.6%。对于PAF和PeAF，CF消融手术优于OIT消融手术（P <.0001），且两者均优于SBT消融手术（P <.001）。在各个时代，LsAF的疗效均未改善。CF、OIT和SBT导管时代最终消融术后的8年成功率如下：PAF为79.1%、71.8%、60.0%；PeAF为55.9%、50.7%、38.0%；LsAF为42.7%、36.2%、31.8%。房颤复发率最高的是在最初2年，2至15年的复发率为每年2%。初次和最终消融术后的成功预测因素包括年龄较小、左心房较小、房颤持续时间较短、男性、持续性房颤较少、CHADS-VASc评分较低、失败药物较少以及较新的导管时代。
结论
2年后，所有类型房颤的年复发率为2%。CF导管时代的消融成功率最高，OIT时代次之，SBT时代最差。在各个消融时代，PAF和PeAF的疗效有所改善，但LsAF未改善。消融术后我们应无限期地随访患者。我们需要了解如何更好地消融更持续性的房颤。
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