持续性心房颤动线性消融的五年随访结果

Long-term effects of stepwise linear ablation approach in persistent atrial fibrillation

目的导管消融对于持续性心房颤动（房颤）的远期疗效存在争议，本研究旨在观察基于心房基质改良的线性消融对持续性房颤的远期疗效，并探讨消融术式与消融远期成功率的关系。方法回顾性分析了87例因药物无效而接受了步进式线性消融的持续性或长程持续性房颤病例，依据房颤能否被消融转复为窦性心律分为消融转复组和消融加电复律组并平均随访至术后5．3年。结果87例患者中有50例（57．5％）术中通过线性消融直接终止了房颤，37例（42．5％）患者线性消融无法转复，除1例之外均行电复律成功。平均随访（5．3±1．0）年，单次消融后34例（39％）患者维持窦性心律，其中消融转复组24例（48％），消融加电复律组10例（27％）可维持窦性心律，消融转复组的远期成功率高于？肖融加电复律组（P=0．047）。结论对于持续性或长程持续性房颤患者，通过线性消融策略进行心房基质改良消融可能有助于提高远期成功率。术中通过消融直接转复为窦性心律是远期成功率的预测因素。

Objective The long-term effects of catheter ablation in patients with persistent atrial fibrillation were controversial.The purpose of this study was to observe the long-term effects of persistent atrial fi- brillation ablation using a stepwise linear ablation approach. Methods Eighty-seven patients with drug-refrac- tory persistent atrial fibrillation underwent radiofrequency catheter linear ablation between January 2005 and De- cember 2007 were enrolled.Patients were divided into two groups as ablation convertion group and ablation plus cardioversion group according to the sinus restoration. Results Sinus rhythm was restored directly by linear ablation in 50 patients （57.5%）, the others were converted by cardioversion post intensive linear ablation ex- cept 1 patient （failed）.There was a higher success in ablation convertion group compared with ablation plus cardioversion group （48% vs.27%, P = 0. 047）. Conclusion Linear ablation strategy which aimed at atrial substate modification, may improve the long-term efficacy of cathetdr ablation for persistent atrial fibrillation.Sinus rhythm restoration by ablation was a predictive factor for long-term outcome.