摘要
Catheter ablation of persistent atrial fibrillation (AF) remains a challenging task.The long-term clini-cal outcome and predictors for the recurrence of atrial arrhythmias after ablation has not been consistent.Methods We analyzed the clinical outcome of 103 consecutive patients with a follow-up > 12 months who underwent catheter ablation for persistent AF.We studied their clinical data in terms of age,AF duration,concomitant dieases (hypertension,dia-betes or mitral insuffciency) ,left atrial diameter,catheter ablation strategies (circumferential pulmonary vein ablation, complex ablation) and the follow-up rhythm.COX proportional hazard multivariate regression analysis was performed to identify the predictors of recurrent atrial arrhythmias after ablation.Results There were 85 males and 18 females with a mean age of 55.5 ± 11.9 years old.After a following-up of 26.7 ± 13.8 months (12 -61) ,89 patients (86.4%) remained sinus rhythm(SR) ,including 67(65.0%) undergoing single procedure,2(1.9%) with recurrent atrial tachycardia(AT) undergoing successful cardioversion by drug (amiodarone) ,and 20 under going re-ablation.Fourteen failure cases included 8 unsuccessful patients with chronic AF who refused re-ablation,5 failure cases after re-ablation and 1 remaining AF after surgical ablation.The successful rate of repeat procedure was 76.9% (20 /26) .COX regression analysis indicated that the predictors for recurrence were hypertension (OR = 8.251,P = 0.024) ,1AF dura-tion (OR = 1.108,P = 0.013) ,and mitral insufficiency (OR = 8.982,P = 0.009) .Complex ablation strategy (cir-cumferential pulmonary vein ablation + line ablation + CFAE + linear ablation along the atrial side of coronary sinus) decreased the risk of recurrence (OR = 0.004,P = 0.009) .Conclusions Successful rate of ablation for persistent AF after the first 12 months was high.Repeat procedure could further improve the sinus rate.Hypertension,AF duration and mitral insuffciency were independent predictors of recurrent atrial arrhythmias after persistent AF ablation,but the complex ablation strategy may reduce the risk.
Catheter ablation of persistent atrial fibrillation (AF) remains a challenging task.The long-term clini-cal outcome and predictors for the recurrence of atrial arrhythmias after ablation has not been consistent.Methods We analyzed the clinical outcome of 103 consecutive patients with a follow-up > 12 months who underwent catheter ablation for persistent AF.We studied their clinical data in terms of age,AF duration,concomitant dieases (hypertension,dia-betes or mitral insuffciency) ,left atrial diameter,catheter ablation strategies (circumferential pulmonary vein ablation, complex ablation) and the follow-up rhythm.COX proportional hazard multivariate regression analysis was performed to identify the predictors of recurrent atrial arrhythmias after ablation.Results There were 85 males and 18 females with a mean age of 55.5 ± 11.9 years old.After a following-up of 26.7 ± 13.8 months (12 -61) ,89 patients (86.4%) remained sinus rhythm(SR) ,including 67(65.0%) undergoing single procedure,2(1.9%) with recurrent atrial tachycardia(AT) undergoing successful cardioversion by drug (amiodarone) ,and 20 under going re-ablation.Fourteen failure cases included 8 unsuccessful patients with chronic AF who refused re-ablation,5 failure cases after re-ablation and 1 remaining AF after surgical ablation.The successful rate of repeat procedure was 76.9% (20 /26) .COX regression analysis indicated that the predictors for recurrence were hypertension (OR = 8.251,P = 0.024) ,1AF dura-tion (OR = 1.108,P = 0.013) ,and mitral insufficiency (OR = 8.982,P = 0.009) .Complex ablation strategy (cir-cumferential pulmonary vein ablation + line ablation + CFAE + linear ablation along the atrial side of coronary sinus) decreased the risk of recurrence (OR = 0.004,P = 0.009) .Conclusions Successful rate of ablation for persistent AF after the first 12 months was high.Repeat procedure could further improve the sinus rate.Hypertension,AF duration and mitral insuffciency were independent predictors of recurrent atrial arrhythmias after persistent AF ablation,but the complex ablation strategy may reduce the risk.
基金
Supported by Science and Technology Planning Project of Guangdong Province(2008A030201030)
