Department of Cardiology, The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
The Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia.
Eur Heart J. 2024 Aug 3;45(29):2604-2616. doi: 10.1093/eurheartj/ehae291.
Patterns of atrial fibrillation (AF) recurrence post-catheter ablation for persistent AF (PsAF) are not well described. This study aimed to describe the pattern of AF recurrence seen following catheter ablation for PsAF and the implications for healthcare utilization and quality of life (QoL).
This was a post-hoc analysis of the CAPLA study, an international, multicentre study that randomized patients with symptomatic PsAF to pulmonary vein isolation plus posterior wall isolation or pulmonary vein isolation alone. Patients underwent twice daily single lead ECG, implantable device monitoring or three monthly Holter monitoring.
154 of 333 (46.2%) patients (median age 67.3 years, 28% female) experienced AF recurrence at 12-month follow-up. Recurrence was paroxysmal in 97 (63%) patients and persistent in 57 (37%). Recurrence type did not differ between randomization groups (P = .508). Median AF burden was 27.4% in PsAF recurrence and .9% in paroxysmal AF (PAF) recurrence (P < .001). Patients with PsAF recurrence had lower baseline left ventricular ejection fraction (PsAF 50% vs. PAF 60%, P < .001) and larger left atrial volume (PsAF 54.2 ± 19.3 mL/m² vs. PAF 44.8 ± 11.6 mL/m², P = .008). Healthcare utilization was significantly higher in PsAF (45 patients [78.9%]) vs. PAF recurrence (45 patients [46.4%], P < .001) and lowest in those without recurrence (17 patients [9.5%], P < .001). Patients without AF recurrence had greater improvements in QoL as assessed by the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire (Δ33.3 ± 25.2 points) compared to those with PAF (Δ24.0 ± 25.0 points, P = .012) or PsAF (Δ13.4 ± 22.9 points, P < .001) recurrence.
AF recurrence is more often paroxysmal after catheter ablation for PsAF irrespective of ablation strategy. Recurrent PsAF was associated with higher AF burden, increased healthcare utilization and antiarrhythmic drug use. The type of AF recurrence and AF burden may be considered important endpoints in clinical trials investigating ablation of PsAF.
持续性心房颤动（PsAF）导管消融后心房颤动（AF）复发的模式尚不清楚。本研究旨在描述 PsAF 导管消融后观察到的 AF 复发模式及其对医疗保健利用和生活质量（QoL）的影响。
这是 CAPLA 研究的事后分析，这是一项国际多中心研究，将有症状的 PsAF 患者随机分为肺静脉隔离加后壁隔离组或肺静脉隔离组。患者接受每日两次单导联心电图、植入式设备监测或每三个月进行一次动态心电图监测。
12 个月随访时，333 例患者中有 154 例（中位年龄 67.3 岁，28%为女性）发生 AF 复发。97 例（63%）为阵发性复发，57 例（37%）为持续性复发。复发类型在随机分组之间无差异（P=0.508）。PsAF 复发的 AF 负荷中位数为 27.4%，阵发性 AF（PAF）复发的 AF 负荷中位数为 0.9%（P<0.001）。PsAF 复发患者的左心室射血分数基线较低（PsAF 50% vs. PAF 60%，P<0.001），左心房容积较大（PsAF 54.2±19.3 ml/m2 vs. PAF 44.8±11.6 ml/m2，P=0.008）。PsAF 复发患者（45 例[78.9%]）的医疗保健利用率明显高于 PAF 复发患者（45 例[46.4%]，P<0.001），无复发患者（17 例[9.5%]）最低（P<0.001）。无 AF 复发患者的生活质量改善程度更高，心房颤动生活质量问卷（AFEQT）评估的改善程度（Δ33.3±25.2 分）明显高于 PAF 复发患者（Δ24.0±25.0 分，P=0.012）或 PsAF 复发患者（Δ13.4±22.9 分，P<0.001）。
导管消融治疗 PsAF 后，AF 复发更常为阵发性，而与消融策略无关。持续性 PsAF 与更高的 AF 负荷、更高的医疗保健利用率和抗心律失常药物的使用有关。AF 复发的类型和 AF 负荷可被视为评估 PsAF 消融临床试验的重要终点。
