Impact of Recurrence-to-Repeat Ablation Time on Long-Term Efficacy and Safety of Patients With Paroxysmal Atrial Fibrillation: Time Matters.

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Yuen Hoong Phang, Ting-Yung Chang, Shih-Lin Chang, Yenn-Jiang Lin, Li-Wei Lo, Yu-Feng Hu, Fa-Po Chung, Chin-Yu Lin, Ling Kuo, Chih-Min Liu, Shih-Ann Chen
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引用次数: 0

Abstract

Background: Rhythm control with catheter ablation has been established in the management of atrial fibrillation (AF), but the recurrence of AF remains significant. Several studies have demonstrated the benefits of repeat catheter ablation in patients with recurrent AF. However, the optimal timing for repeat ablation to minimize adverse atrial remodeling following recurrence has not been adequately investigated. In this study, we aimed to determine if an optimal timing for repeat catheter ablation existed in patients with recurrent AF.

Method: We retrospectively screened 1131 patients receiving AF ablation at Taipei Veterans General Hospital and enrolled patients with paroxysmal AF undergoing repeat ablation procedures. Finally, 65 patients were enrolled for further analysis and patients are separated into two groups according to analysis of receiver operating characteristic (ROC) curve of recurrence to repeat ablation time (RAT).

Result: After analysis, the optimal RAT was 222 days, around 7.5 months, with a sensitivity of 56% and a specificity of 78% for 2nd recurrence. KM survival curve also demonstrated Group 2 (RAT ≥ 222) had higher recurrence of atrial arrhythmias after 2nd ablation (p = 0.01). In multivariable analysis, RAT was shown to be an independent predictor of long-term outcome in patient with AF.

Conclusion: Our study suggests that early repeat ablation might be advantageous in managing AF, extending arrhythmia-free intervals, and potentially preventing progression to more persistent arrhythmic forms. Given AF's progressive nature, these results advocate for early intervention strategies aimed at minimizing adverse atrial remodeling and enhancing quality of life for patients.

反复消融时间对阵发性心房颤动患者长期疗效和安全性的影响:时间问题。
背景:心律控制与导管消融已经建立在心房颤动(AF)的管理,但房颤的复发仍然显著。几项研究已经证明反复导管消融对复发性房颤患者的益处。然而,反复消融的最佳时机以最小化复发后不良心房重构尚未得到充分研究。在这项研究中,我们的目的是确定复发性房颤患者是否存在最佳的导管消融时间。方法:我们回顾性筛选了1131例在台北退伍军人总医院接受房颤消融治疗的患者,并纳入了反复消融治疗的阵发性房颤患者。最终纳入65例患者进行进一步分析,根据复发至重复消融时间(RAT)的受试者工作特征(ROC)曲线分析将患者分为两组。结果:经分析,最佳RAT为222天,约7.5个月,第二次复发的敏感性56%,特异性78%。KM生存曲线还显示,第2组(RAT≥222)第2次消融后心房心律失常复发率较高(p = 0.01)。在多变量分析中,RAT被证明是AF患者长期预后的独立预测因子。结论:我们的研究表明,早期重复消融可能有利于治疗AF,延长无心律失常间隔,并有可能防止进展为更持久的心律失常形式。鉴于房颤的进行性,这些结果提倡旨在减少不良心房重构和提高患者生活质量的早期干预策略。
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来源期刊
CiteScore
5.20
自引率
14.80%
发文量
433
审稿时长
3-6 weeks
期刊介绍: Journal of Cardiovascular Electrophysiology (JCE) keeps its readership well informed of the latest developments in the study and management of arrhythmic disorders. Edited by Bradley P. Knight, M.D., and a distinguished international editorial board, JCE is the leading journal devoted to the study of the electrophysiology of the heart.
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