Background The optimal endpoint for catheter ablation of persistent atrial fibrillation （AF） remains ambiguous. This study investigated the impact of AF termination as a procedural endpoint and the termination mode ...Background The optimal endpoint for catheter ablation of persistent atrial fibrillation （AF） remains ambiguous. This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome. Methods Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion （CV） group. Subgroups were also analyzed based on different termination modes. Follow-up assessment included early recurrence and sinus rhythm （SR） maintenance. Results During initial ablation, 33 patients （11.3%） were directly converted to SR, 166 patients （56.7%） were converted to atrial tachycardia （AT） that subsequently restored SR with further ablation in 98 patients （33.4%）, and a total of 162 patients （55.3%） underwent cardioversion due to persistent atrial arrhythmias. Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence （38.2% vs. 43.8%, P=0.328） and SR maintenance （67.2% vs. 59.8%, P=0.198） during the （23±7） months follow-up. Even after repeat ablation, the SR maintenance continued to exhibit no statistical difference in above two groups （72.5% vs. 70.4%, P=0.686）. Further analysis of subgroups, however, demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups （P 〈0.05）. Furthermore, atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode： AF or AT （P 〈0.05）. Conclusions Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF. AF methods that convert arrhythmia directly to SR have, however, been linked with improved clinical outcomes, although conversions to AT may not be correlated. Atrial arrhythmias observed during the ablation may be used to predict the recurrence mode.展开更多
Background HATCH score is an established predictor of progression from paroxysmal to persistent atrial fibrillation （AF）. The purpose of this study was to determine if HATCH score could predict recurrence after cath...Background HATCH score is an established predictor of progression from paroxysmal to persistent atrial fibrillation （AF）. The purpose of this study was to determine if HATCH score could predict recurrence after catheter ablation of AF. Methods The data of 488 consecutive paroxysmal AF patients who underwent an index circumferential pulmonary veins （PV） ablation were retrospectively analyzed. Of these patients, 250 （51.2%） patients had HATCH score=0, 185 （37.9%） patients had HATCH score=l, and 53 （10.9%） patients had HATCH score 〉2 （28 patients had HATCH score=2, 23 patients had HATCH score=3, and 2 patients had HATCH score=4）. Results The patients with HATCH score 〉2 had significantly larger left atrium size, the largest left ventricular end systolic diameter, and the lowest ejection fraction. After a mean follow-up of （823＋532） days, the recurrence rates were 36.4%, 37.8% and 28.3% from the HATCH score=0, HATCH score=l to HATCH score 〉2 categories （P=0.498）. Univariate analysis revealed that left atrium size, body mass index, and failure of PV isolation were predictors of AF recurrence. After adjustment for body mass index, left atrial size and PV isolation, the HATCH score was not an independent predictor of recurrence （HR=0.92, 95% confidence interval=0.76-1.12, P=0.406） in multivariate analysis. Conclusion HATCH score has no value in prediction of AF recurrence after catheter ablation.展开更多
基金This work was supported by grants from the National Natural Science Foundation of China （No. 30971239 and No. 81070147）, Beijing Natural Science Foundation （No. 7101004）.
文摘Background The optimal endpoint for catheter ablation of persistent atrial fibrillation （AF） remains ambiguous. This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome. Methods Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion （CV） group. Subgroups were also analyzed based on different termination modes. Follow-up assessment included early recurrence and sinus rhythm （SR） maintenance. Results During initial ablation, 33 patients （11.3%） were directly converted to SR, 166 patients （56.7%） were converted to atrial tachycardia （AT） that subsequently restored SR with further ablation in 98 patients （33.4%）, and a total of 162 patients （55.3%） underwent cardioversion due to persistent atrial arrhythmias. Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence （38.2% vs. 43.8%, P=0.328） and SR maintenance （67.2% vs. 59.8%, P=0.198） during the （23±7） months follow-up. Even after repeat ablation, the SR maintenance continued to exhibit no statistical difference in above two groups （72.5% vs. 70.4%, P=0.686）. Further analysis of subgroups, however, demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups （P 〈0.05）. Furthermore, atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode： AF or AT （P 〈0.05）. Conclusions Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF. AF methods that convert arrhythmia directly to SR have, however, been linked with improved clinical outcomes, although conversions to AT may not be correlated. Atrial arrhythmias observed during the ablation may be used to predict the recurrence mode.
基金This work was supported by the National Science Foundation Council of China （No. 30900628, 81070147）, Beijing Natural Science Foundation （No. 7102048） and Beijing Nova Program （No. 2009B32） and Training Program for Excellent Talent of Beijing （No. 2010D003034000025）.
文摘Background HATCH score is an established predictor of progression from paroxysmal to persistent atrial fibrillation （AF）. The purpose of this study was to determine if HATCH score could predict recurrence after catheter ablation of AF. Methods The data of 488 consecutive paroxysmal AF patients who underwent an index circumferential pulmonary veins （PV） ablation were retrospectively analyzed. Of these patients, 250 （51.2%） patients had HATCH score=0, 185 （37.9%） patients had HATCH score=l, and 53 （10.9%） patients had HATCH score 〉2 （28 patients had HATCH score=2, 23 patients had HATCH score=3, and 2 patients had HATCH score=4）. Results The patients with HATCH score 〉2 had significantly larger left atrium size, the largest left ventricular end systolic diameter, and the lowest ejection fraction. After a mean follow-up of （823＋532） days, the recurrence rates were 36.4%, 37.8% and 28.3% from the HATCH score=0, HATCH score=l to HATCH score 〉2 categories （P=0.498）. Univariate analysis revealed that left atrium size, body mass index, and failure of PV isolation were predictors of AF recurrence. After adjustment for body mass index, left atrial size and PV isolation, the HATCH score was not an independent predictor of recurrence （HR=0.92, 95% confidence interval=0.76-1.12, P=0.406） in multivariate analysis. Conclusion HATCH score has no value in prediction of AF recurrence after catheter ablation.
