Impact of type of atrial fibrillation and repeat catheter ablation on long-term freedom from atrial fibrillation: Results from a multicenter study

被引：211

作者：

Bhargava, Mandeep ^{[2
]}

Di Biase, Luigi ^{[1
,2
,9
]}

Mohanty, Prasant ^{[1
]}

Prasad, Subramanyam ^{[2
]}

Martin, David O. ^{[2
]}

Williams-Andrews, Michelle ^{[2
]}

Wazni, Oussama M. ^{[2
]}

Burkhardt, J. David ^{[1
]}

Cummings, Jennifer E. ^{[2
]}

Khaykin, Yaariv ^{[5
]}

Verma, Atul ^{[5
]}

Hao, Steven ^{[3
]}

Beheiry, Salwa ^{[3
]}

Hongo, Richard ^{[3
]}

Rossillo, Antonio ^{[4
]}

Raviele, Antonio ^{[4
]}

Bonso, Aldo ^{[4
]}

Themistoclakis, Sakis ^{[4
]}

Stewart, Kelly ^{[2
]}

Saliba, Walid I. ^{[2
]}

Schweikert, Robert A. ^{[6
]}

Natale, Andrea ^{[1
,7
,8
]}

机构：

[1] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, Austin, TX 78705 USA

[2] Cleveland Clin, Cleveland, OH 44106 USA

[3] Calif Pacific Med Ctr, San Francisco, CA USA

[4] Umberto I Hosp, Mestre Venice, Italy

[5] Southlake Reg Hlth Ctr, Newmarket, ON, Canada

[6] Akron Gen Med Ctr, Akron, OH USA

[7] Stanford Univ, Palo Alto, CA 94304 USA

[8] Case Western Reserve Univ, Cleveland, OH 44106 USA

[9] Univ Foggia, Dept Cardiol, Foggia, Italy

来源：

HEART RHYTHM | 2009年 / 6卷 / 10期

关键词：

Atrial fibrillation; Catheter ablation; Nonparoxysmal; long-standing persistent atrial fibrillation; VEIN ANTRUM ISOLATION; PULMONARY VEINS; ELECTRICAL ISOLATION; TIP;

D O I：

10.1016/j.hrthm.2009.06.014

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND/OBJECTIVE The purpose of this prospective multi-center study was to compare results of catheter ablation in patients with paroxysmal atrial fibrillation (PAF) and those with nonparoxysmal atrial fibrillation (NPAF). The impact and the role of repeat catheter ablation were assessed in patients with recurrence. METHODS/RESULTS One thousand four hundred four patients underwent catheter ablation for atrial fibrillation (AF) performed by 12 operators at four institutions using a single technique guided by intracardiac echocardiography. Of these patients, 728 had PAF and 676 had NPAF. Among the NPAF patients, 293 had persistent AF and 383 had long-standing persistent AF. Patients with NPAF had a higher incidence of hypertension and/or structural heart disease (64.8% vs 48.5%, P = .003) and a lower mean left ventricular ejection fraction (53.3% +/- 8.7% vs 55.7 +/- 6.5%, P < .001). All patients underwent antral isolation of all four pulmonary veins and the superior vena cava. At mean follow-up of 57 +/- 17 months, 565 of 728 patients with PAF and 454 of 676 patients with NPAF (77.6% vs 67.2%, P < .001) had freedom from AF after a single ablation procedure. For arrhythmia recurrences, 74.2% (121/163) patients with PAF and 74.8% (166/222) with NPAF underwent repeat ablation, after which 92.4% patients with PAF and 84.0% patients with NPAF remained free from AF. CONCLUSION Pulmonary vein antrum isolation guided by intracardiac echocardiography results in significant freedom from AF, even when performed by multiple operators in different centers. At least moderate efficacy can be achieved in patients with NPAF, although the success rate is tower than in patients with PAF. Considerably higher success can be achieved in both groups with repeat ablation.

引用

页码：1403 / 1412

页数：10

共 21 条

[1] Electrical isolation of the superior vena cava: An adjunctive strategy to pulmonary vein antrum isolation improving the outcome of AF ablation [J].

Arruda, Mauricio ;

Mlcochova, Hanka ;

Prasad, Subramanya K. ;

Kilicaslan, Fethi ;

Saliba, Walid ;

Patel, Dimpi ;

Fahmy, Tamer ;

Morales, Luis Saenz ;

Schweikert, Robert ;

Martin, David ;

Burkhardt, David ;

Cummings, Jennifer ;

Bhargava, Mandeep ;

Dresing, Thomas ;

Wazni, Oussama ;

Kanj, Mohamed ;

Natale, Andrea .

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2007, 18 (12) :1261-1266

[2] Impact of age on the outcome of pulmonary vein isolation for atrial fibrillation using circular mapping technique and cooled-tip ablation catheter: A retrospective analysis [J].

Bhargava, M ;

Marrouche, NF ;

Martin, DO ;

Schweikert, RA ;

Saliba, W ;

Saad, EB ;

Bash, D ;

Williams-Andrews, M ;

Rossillo, A ;

Erciyes, D ;

Khaykin, Y ;

Burkhardt, JD ;

Joseph, G ;

Tchou, PJ ;

Natale, A .

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2004, 15 (01) :8-13

[3]

BHARGAVA M, 2006, MANUAL INTRACARDIAC, P59

[4] HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for personnel, policy, procedures and follow-up [J].

Calkins, Hugh ;

Brugada, Josep ;

Packer, Douglas L. ;

Cappato, Riccardo ;

Chen, Shih-Ann ;

Crijns, Harry J. G. ;

Damiano, Ralph J., Jr. ;

Davies, D. Wyn ;

Haines, David E. ;

Haissaguerre, Michel ;

Iesaka, Yoshito ;

Jackman, Warren ;

Jais, Pierre ;

Kottkamp, Hans ;

Kuck, Karl Heinz ;

Lindsay, Bruce D. ;

Marchlinski, Francis E. ;

McCarthy, Patrick M. ;

Mont, J. Lluis ;

Morady, Fred ;

Nademanee, Koontawee ;

Natale, Andrea ;

Pappone, Carlo ;

Prystowsky, Eric ;

Raviele, Antonio ;

Ruskin, Jeremy N. ;

Shemin, Richard J. .

HEART RHYTHM, 2007, 4 (06) :816-861

[5] Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function [J].

Chen, MS ;

Marrouche, NF ;

Khaykin, Y ;

Gillinov, AM ;

Wazni, O ;

Martin, DO ;

Rossillo, A ;

Verma, A ;

Cummings, J ;

Erciyes, D ;

Saad, E ;

Bhargava, M ;

Bash, D ;

Schweikert, R ;

Burkhardt, D ;

Williams-Andrews, M ;

Perez-Lugones, A ;

Abdul-Karim, A ;

Saliba, W ;

Natale, A .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 43 (06) :1004-1009

[6] Pulmonary vein total occlusion following catheter ablation for atrial fibrillation - Clinical implications after long-term follow-up [J].

Di Biase, Luigi ;

Fahmy, Tamer S. ;

Wazni, Oussama M. ;

Bai, Rong ;

Patel, Dimpi ;

Lakkireddy, Dhanunjaya ;

Cummings, Jennifer E. ;

Schweikert, Robert A. ;

Burkhardt, J. David ;

Elayi, Claude S. ;

Kanj, Mohamed ;

Popova, Lucie ;

Prasad, Subramanya ;

Martin, David O. ;

Prieto, Lourdes ;

Saliba, Walid ;

Tchou, Patrick ;

Arruda, Mauricio ;

Natale, Andrea .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 48 (12) :2493-2499

[7] Comparison of cool tip versus 8-mm tip catheter in achieving electrical isolation of pulmonary veins for long-term control of atrial fibrillation: A prospective randomized pilot study [J].

Dixit, Sanjay ;

Gerstenfeld, Edward P. ;

Callans, David J. ;

Cooper, Joshua M. ;

Lin, David ;

Russo, Andrea M. ;

Verdino, Ralph J. ;

Patel, Vickas V. ;

Kimmel, Stephen E. ;

Ratcliffe, Sarah J. ;

Hsia, Henry H. ;

Nayak, Hemal M. ;

Zado, Erica ;

Ren, Jian-Fang ;

Marchlinski, Francis E. .

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2006, 17 (10) :1074-1079

[8] ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation - Executive summary [J].

Fuster, Valentin ;

Ryden, Lars E. ;

Cannom, David S. ;

Crijns, Harry J. ;

Curbs, Anne B. ;

Ellenbogen, Kenneth A. ;

Halperin, Jonathan L. ;

Le Heuzey, Jean-Yves ;

Kay, G. Neal ;

Lowe, James E. ;

Olsson, S. Bertil ;

Prystowsky, Eric N. ;

Tamargo, Juan Luis ;

Wann, Samuel ;

Smith, Sidney C., Jr. ;

Jacobs, Alice K. ;

Adams, Cynthia D. ;

Anderson, Jeffery L. ;

Antman, Elliott M. ;

Halperin, Jonathan L. ;

Hunt, Sharon Ann ;

Nishimura, Rick ;

Ornato, Joseph P. ;

Page, Richard L. ;

Riegel, Barbara ;

Priori, Silvia G. ;

Blanc, Jean-Jacques ;

Budaj, Andrzej ;

Camm, A. John ;

Dean, Veronica ;

Deckers, Jaap W. ;

Despres, Catherine ;

Dickstein, Kenneth ;

Lekakis, John ;

McGregor, Keith ;

Metra, Marco ;

Morais, Joao ;

Osterspey, Ady ;

Tamargo, Juan Luis ;

Zamorano, Jose Luis .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 48 (04) :854-906

[9] Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins [J].

Haïssaguerre, M ;

Jaïs, P ;

Shah, DC ;

Takahashi, A ;

Hocini, M ;

Quiniou, G ;

Garrigue, S ;

Le Mouroux, A ;

Le Métayer, P ;

Clémenty, J .

NEW ENGLAND JOURNAL OF MEDICINE, 1998, 339 (10) :659-666

[10] Atrial fibrillation: Multi-detector row CT of pulmonary vein anatomy prior to radiofrequency catheter ablation - Initial experience [J].

Jongbloed, MRM ;

Dirksen, MS ;

Bax, JJ ;

Boersmo, E ;

Geleijns, K ;

Lamb, HJ ;

van der Wall, EE ;

de Roos, A ;

Schalij, MJ .

RADIOLOGY, 2005, 234 (03) :702-709

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