Aims: We conducted a multi- centre, prospective, controlled, randomize d rial to investigate the adjunctive role of ablation therapy to antiarrhythmic drug therapy in preventing atrial fibrillation(AF) relapses in pat...Aims: We conducted a multi- centre, prospective, controlled, randomize d rial to investigate the adjunctive role of ablation therapy to antiarrhythmic drug therapy in preventing atrial fibrillation(AF) relapses in patients with paroxysmal or persistent AF in whom antiarrhythmic drug therapy had already failed. Methods and results: One hundred and thirty seven patients were randomized to ablation and antiarrhythmic drug therapy(ablation group) or antiarrhythmic drug therapy alone(control group). In the ablation group, patients underwent cavo- tricuspid and left inferior pulmonary vein(PV)- mitral isthmus ablation plus circumferential PV ablation. The primary end- point of the study was the absence of any recurrence of atrial arrhythmia lasting >30s in the 1- year follow- up period, after 1- month blanking period. Three(4.4% ) major complications were related to ablation: one patient had a stroke during left atrium ablation, another suffered transient phrenic paralysis, and the third had a pericardial effusion which required pericardiocentesis. After 12 months of follow- up, 63/69(91.3% ) control group patients had at least one AF recurrence, whereas 30/68(44.1% )(P < 0001) ablation group patients had atrial arrhythmia recurrence(four patients had atrial flutter, 26 patients AF). Conclusion: Ablation therapy combined with antiarrhythmic drug therapy is superior to antiarrhythmic drug therapy alone in preventing atrial arrhythmia recurrences in patients with paroxysmal or persistent AF in whom antiarrhythmic drug therapy has already failed.展开更多
OBJECTIVES: The aim of our study was to determine the incidence of asymptomatic recurrences of atrial fibrillation(AF) by daily transtelephonic(TT) electrocardiographic(ECG) monitoring, as compared with standard ECG a...OBJECTIVES: The aim of our study was to determine the incidence of asymptomatic recurrences of atrial fibrillation(AF) by daily transtelephonic(TT) electrocardiographic(ECG) monitoring, as compared with standard ECG and 24-h Holter recording, in patients who underwent radiofrequency catheter ablation(RCA) of AF. BACKGROUND: The efficacy of RCA of AF is usually evaluated by means of patients’symptoms. METHODS: Seventy-two patients with paroxysmal(n=37) or persistent(n=35) drug-refractory AF underwent circumferential RCA of the pulmonary vein(PV) ostia. Left isthmus ablation was performed in 57 patients, and cavotricuspid isthmus ablation was done in 69 patients. Patients were scheduled to obtain an ECG and Holter recordings one and four months after ablation, as well as a daily TT ECG, from 30 to 120 days after ablation or in the event of symptoms. RESULTS:A total of 5,585 TT ECGs were obtained(mean 77.5 per patient). In 20 patients(27.8%), AF recurrences were recorded during TT ECG, whereas ECG and Holter monitoring revealed AF recurrences in 10 patients(13.9%, p=0.001). Ten patients had at least one asymptomatic AF recurrence, and eight were completely asymptomatic. The ECG recorded in the event of symptoms always showed AF. CONCLUSIONS: Transtelephonic ECG is better than standard ECG and 24-h Holter recordings in evaluating AF relapses after RCA, thus decreasing the short-term success of ablation from 86%to 72%. The absence of symptoms should not be interpreted as absence of AF, as 50%of patients were asymptomatic during at least one AF episode.展开更多
文摘Aims: We conducted a multi- centre, prospective, controlled, randomize d rial to investigate the adjunctive role of ablation therapy to antiarrhythmic drug therapy in preventing atrial fibrillation(AF) relapses in patients with paroxysmal or persistent AF in whom antiarrhythmic drug therapy had already failed. Methods and results: One hundred and thirty seven patients were randomized to ablation and antiarrhythmic drug therapy(ablation group) or antiarrhythmic drug therapy alone(control group). In the ablation group, patients underwent cavo- tricuspid and left inferior pulmonary vein(PV)- mitral isthmus ablation plus circumferential PV ablation. The primary end- point of the study was the absence of any recurrence of atrial arrhythmia lasting >30s in the 1- year follow- up period, after 1- month blanking period. Three(4.4% ) major complications were related to ablation: one patient had a stroke during left atrium ablation, another suffered transient phrenic paralysis, and the third had a pericardial effusion which required pericardiocentesis. After 12 months of follow- up, 63/69(91.3% ) control group patients had at least one AF recurrence, whereas 30/68(44.1% )(P < 0001) ablation group patients had atrial arrhythmia recurrence(four patients had atrial flutter, 26 patients AF). Conclusion: Ablation therapy combined with antiarrhythmic drug therapy is superior to antiarrhythmic drug therapy alone in preventing atrial arrhythmia recurrences in patients with paroxysmal or persistent AF in whom antiarrhythmic drug therapy has already failed.
文摘OBJECTIVES: The aim of our study was to determine the incidence of asymptomatic recurrences of atrial fibrillation(AF) by daily transtelephonic(TT) electrocardiographic(ECG) monitoring, as compared with standard ECG and 24-h Holter recording, in patients who underwent radiofrequency catheter ablation(RCA) of AF. BACKGROUND: The efficacy of RCA of AF is usually evaluated by means of patients’symptoms. METHODS: Seventy-two patients with paroxysmal(n=37) or persistent(n=35) drug-refractory AF underwent circumferential RCA of the pulmonary vein(PV) ostia. Left isthmus ablation was performed in 57 patients, and cavotricuspid isthmus ablation was done in 69 patients. Patients were scheduled to obtain an ECG and Holter recordings one and four months after ablation, as well as a daily TT ECG, from 30 to 120 days after ablation or in the event of symptoms. RESULTS:A total of 5,585 TT ECGs were obtained(mean 77.5 per patient). In 20 patients(27.8%), AF recurrences were recorded during TT ECG, whereas ECG and Holter monitoring revealed AF recurrences in 10 patients(13.9%, p=0.001). Ten patients had at least one asymptomatic AF recurrence, and eight were completely asymptomatic. The ECG recorded in the event of symptoms always showed AF. CONCLUSIONS: Transtelephonic ECG is better than standard ECG and 24-h Holter recordings in evaluating AF relapses after RCA, thus decreasing the short-term success of ablation from 86%to 72%. The absence of symptoms should not be interpreted as absence of AF, as 50%of patients were asymptomatic during at least one AF episode.
