Mo Pei, Fan Cheng, Chen Jiayuan, Wang Yu, Xiao Wenhao, Peng Zhiguo, Lin Xiao-Zhen, Luo Cheng-Feng, Zhang Chongyu
Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China.
Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, People's Republic of China.
Ther Clin Risk Manag. 2024 Dec 3;20:817-828. doi: 10.2147/TCRM.S492265. eCollection 2024.
Atrial fibrillation (AF) is classified into paroxysmal, persistent, long-term persistent, and permanent types. It is commonly treated by radiofrequency ablation (RFA), which is more successful than conventional anti-arrhythmic drugs, but it is still largely unknown whether these beneficial effects are equally present for all AF types. Here, we evaluated the impact that AF type has on post-RFA patient conditions and identified underlying factors affecting AF prognoses.
Three hundred and twenty-nine AF patients who underwent RFA were retrospectively examined (221 paroxysmal, 56 persistent, 52 long-term persistent), during a post-RFA follow-up period, from 3-months to 2-years. Cardiac functional parameters, such as left atrial (LA), ventricular (LV), and pulmonary artery diameters, as well as ejection fraction (EF) and end-diastolic/systolic diameter ratio, were measured using echocardiography. Additionally, chronic kidney disease (CKD) was diagnosed among these AF patients, using the Modification of Diet in Renal Disease (MDRD) formula, and its impact on post-RFA patient outcomes was examined. Logistic regression analysis identified differences between AF and non-AF recurrence groups.
In terms of functional parameters, persistent AF had significantly smaller LA, and larger EF, compared to paroxysmal and long-term persistent groups, while paroxysmal had significantly larger LV versus persistent and long-term persistent after RFA. For post-RFA patient conditions, paroxysmal, compared to persistent and long-term persistent, had significantly lower AF recurrence (18.10% versus 30.36% and 36.54%) and re-hospitalization rates (6.79% versus 14.29% and 19.23%); however, no significant difference was present between the 3 groups in terms of post-operative stroke rates, as well as re-hospitalization duration. Additionally, CKD patients, versus non-CKD, were more prone to AF recurrence and re-hospitalization, being 3.268 times more likely.
AF types and CKD were independent factors influencing AF recurrence, serving as highly sensitive predictors to monitor prognoses and guide treatments. Therefore, personalized treatment regimens should be recommended for different AF patients.
心房颤动（AF）分为阵发性、持续性、长期持续性和永久性类型。其通常采用射频消融（RFA）治疗，该方法比传统抗心律失常药物更有效，但这些有益效果是否在所有AF类型中均同样存在仍 largely unknown。在此，我们评估了AF类型对RFA术后患者状况的影响，并确定了影响AF预后的潜在因素。
对329例行RFA的AF患者进行回顾性研究（阵发性221例、持续性56例、长期持续性52例），在RFA术后3个月至2年的随访期内进行。使用超声心动图测量心脏功能参数，如左心房（LA）、心室（LV）和肺动脉直径，以及射血分数（EF）和舒张末期/收缩末期直径比。此外，使用肾病饮食改良（MDRD）公式在这些AF患者中诊断慢性肾脏病（CKD），并检查其对RFA术后患者结局的影响。逻辑回归分析确定了AF复发组和非AF复发组之间的差异。
在功能参数方面，与阵发性和长期持续性组相比，持续性AF的LA明显较小，EF较大，而阵发性AF在RFA术后的LV明显大于持续性和长期持续性AF。对于RFA术后患者状况，与持续性和长期持续性AF相比，阵发性AF的复发率（18.10%对30.36%和36.54%）和再住院率（6.79%对14.29%和19.23%）明显较低；然而，三组在术后卒中率以及再住院时长方面无显著差异。此外，CKD患者比非CKD患者更容易发生AF复发和再住院，可能性高3.268倍。
AF类型和CKD是影响AF复发的独立因素，是监测预后和指导治疗的高度敏感预测指标。因此，应针对不同的AF患者推荐个性化治疗方案。
