CIRCULATION：非阵发性房颤患者导管消融的临床预后仍不理想

导管消融是治疗房颤的一种有效地治疗手段，尤其是对于药物治疗效果不佳或不能耐受药物治疗的患者，近年来，导管消融的适应症已扩展到非阵发性房颤患者，但是目前还缺乏非阵发性房颤导管消融的长期成功率的数据，该项研究旨在调查非持续房颤患者导管消融治疗的长期预后。

研究方法：共入选88例非阵发性房颤患者，所有患者均进行了阶梯式的导管消融术（肺静脉隔离+左房基质改良），术后所有患者均接受8周的抗心律失常药物治疗以防止早期复发，并在术后每1-3月进行门诊随访，平均随访时间为36.8月，随访内容包括Holter和/或事件记录器检查，复发定义为手术2月后出现的持续时间大于30秒的房性心律失常发作，并通过心电图记录证实。无复发定义为在未使用任何抗心律失常药物的情况下房颤未再发作。

结果：随访期间有63例患者出现复发，占71.6%；多因素分析提示CHADS2评分≥3分和左房内径是复发的预测因子。对于CHADS2评分≥3分及左房内径>44mm的患者，所有的复发均发生在初次手术后1年内。通过2次手术后无复发率升至47.7%，3次手术的无复发率为51.1%。

结论：非阵发性房颤长时间一次导管消融手术后长时间无复发率仅为28.4%；多次手术可提高无复发率；CHADS2评分和左房内径可帮助临床医师识别易复发的患者。

与房颤相关的拓展阅读：

• CIRCEP：非阵发性房颤患者导管消融的临床预后仍不理想
• 全国首家房颤消融手术万例医院揭牌
• BMJ：亚临床甲状腺病房颤风险升高
• Circulation：肾功能不全独立预测房颤卒中风险
• BMJ：甲状腺功能“正常”者房颤风险攀升与TSH水平有关
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doi: 10.1161/​CIRCEP.111.968032
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Clinical Outcome of Catheter Ablation in Patients with Non-Paroxysmal Atrial Fibrillation: The Results of 3-Year Follow Up

Tze-Fan Chao1, Hsuan-Ming Tsao2, Yenn-Jiang Lin1, Chin-Feng Tsai3, Wei-Shiang Lin4, Shih-Lin Chang1, Li-Wei Lo1, Yu-Feng Hu1, Ta-Chuan Tuan1, Kazuyoshi Suenari5, Cheng-Hung Li1, Beny Hartono6, Hung-Yu Chang7, Kibos Ambrose6, Tsu-Juey Wu8 and Shih-Ann Chen1*

Background—Catheter ablation of atrial fibrillation (AF) became an effective therapy for patients with drug-refractory AF and the indications have broadened to include non-paroxysmal AF patients. However, data about the long-term effectiveness of ablation in patients with non-paroxysmal AF are lacking. The aim of the present study was to investigate the long-term ouctomces of catheter ablation in patients with non-paroxysmal AF. Methods and Results—A total of 88 non-paroxysmal AF patients who received a stepwise catheter ablation (isolation of the pulmonary veins plus substrate modification) from 2006-2008 were enrolled. Freedom of recurrence was defined as the absence of atrial arrhythmias without using any antiarrhythmic agents after the catheter ablation. There were 63 patients (71.6%) suffering from recurrences (47 patients with AF and 16 patients with atrial flutter/atrial tachycardia) after the initial procedure during a median follow-up period of 36.8 months. A CHADS2 score of ≥3 and the left atrial (LA) diameter were significant predictors of recurrences in the multivariable analysis. Of the patients with CHADS2 scores of ≥3 and an LA dimension ≥44mm, all experienced recurrences within 1 year after the initial procedure. The overall recurrence-free rate could increase to 47.7% after the second procedure and 51.1% after the third procedure. Conclusions—The long-term recurrence-free rate of ablation in non-paroxysmal AF was only 28.4% after a single procedure, and multiple procedures were necessary to raise the recurrence-free rate. The CHADS2 score and LA dimension may help us to idenfy patients who will experience recurrences after catheter ablations of non-paroxysmal AF.