Sanchez-Somonte Paula, Kittichamroen Natchayathipk, Gao-Kang Jenny, Azizi Zahra, Alipour Pouria, Kahykin Yaariv, Pantano Alfredo, Verma Atul
Division of Cardiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
Departamento de Medicina, Universitat de Barcelona (UB), Barcelona, Spain.
JACC Adv. 2024 Aug 19;3(9):101200. doi: 10.1016/j.jacadv.2024.101200. eCollection 2024 Sep.
Catheter ablation atrial fibrillation (AF) is effective, but 20% to 40% of patients will require a repeat ablation. The role of more than 1 repeat ablation is not well known.
The purpose of this study was to evaluate the effectiveness and incremental benefits of multiple repeat catheter ablations to treat AF in patients.
We retrospectively included patients who underwent their first, second, third, and fourth AF ablation between 2004 and 2019. They were monitored with a 24-to-48-hour Holter every 3 months postablation the first year and every 6 to 12 months thereafter. Recurrence was defined as documented atrial arrhythmia >30 seconds. Outcomes are analyzed by Kaplan-Meier curves and compared by log rank test.
We included a total of 2,194 patients (64% with paroxysmal and 36% with nonparoxysmal AF). Mean age was 71 ± 10 years; 67% were male. After 1 ablation, freedom from AF was 52%. Among those 1,052 patients who had recurrences, 576 (55%) underwent a second ablation, 103 (10%) underwent a third procedure, and 20 (2%) underwent a fourth. Success rates for the second, third, and fourth ablation were 57%, 60%, and 40%, respectively, at 5-year follow-up. After the second ablation, freedom from AF in our entire cohort increased from 52% to 66%, with marginal changes after the third (67%) and fourth (67%) procedures.
Although repeated ablations demonstrated significant benefits at the individual level, the success rate may drop off after a third. The overall success of the initial cohort was not significantly influenced by the success rates of multiple follow-up ablations.
导管消融治疗心房颤动（AF）是有效的，但20%至40%的患者需要再次消融。多次重复消融的作用尚不明确。
本研究旨在评估多次重复导管消融治疗AF患者的有效性和额外获益。
我们回顾性纳入了2004年至2019年间接受首次、第二次、第三次和第四次AF消融的患者。术后第一年每3个月用24至48小时动态心电图监测，此后每6至12个月监测一次。复发定义为记录到房性心律失常>30秒。结果采用Kaplan-Meier曲线分析，并通过对数秩检验进行比较。
我们共纳入2194例患者（64%为阵发性AF，36%为非阵发性AF）。平均年龄为71±10岁；67%为男性。一次消融后，无AF的比例为52%。在1052例复发患者中，576例（55%）接受了第二次消融，103例（10%）接受了第三次消融，20例（2%）接受了第四次消融。在5年随访时，第二次、第三次和第四次消融的成功率分别为57%、60%和40%。第二次消融后，我们整个队列中无AF的比例从52%增加到66%，第三次（67%）和第四次（67%）消融后变化不大。
尽管重复消融在个体水平上显示出显著益处，但第三次消融后成功率可能会下降。初始队列的总体成功率并未受到多次随访消融成功率的显著影响。
