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著者: Ayman A Hussein, Walid I Saliba, Amr Barakat, Mohammed Bassiouny, Mohammed Chamsi-Pasha, Rasha Al-Bawardy, Ali Hakim, Khaldoun Tarakji, Bryan Baranowski, Daniel Cantillon, Thomas Dresing, Patrick Tchou, David O Martin, Niraj Varma, Mandeep Bhargava, Thomas Callahan, Mark Niebauer, Mohamed Kanj, Mina Chung, Andrea Natale, Bruce D Lindsay, Oussama M Wazni
雑誌名: Circ Arrhythm Electrophysiol. 2016 Jan;9(1):e003669. doi: 10.1161/CIRCEP.115.003669.
Abstract/Text
BACKGROUND: Various ablation strategies of persistent atrial fibrillation (PersAF) have had disappointing outcomes, despite concerted clinical and research efforts, which could reflect progressive atrial fibrillation-related atrial remodeling.
METHODS AND RESULTS: Two-year outcomes were assessed in 1241 consecutive patients undergoing first-time ablation of PersAF (2005-2012). The time intervals between the first diagnosis of PersAF and the ablation procedures were determined. Patients had echocardiograms and measures of B-type natriuretic peptide and C-reactive protein before the procedures. The median diagnosis-to-ablation time was 3 years (25th-75th percentiles 1-6.5). With longer diagnosis-to-ablation time (based on quartiles), there was a significant increase in recurrence rates in addition to an increase in B-type natriuretic peptide levels (P=0.01), C-reactive protein levels (P<0.0001), and left atrial size (P=0.03). The arrhythmia recurrence rates over 2 years were 33.6%, 52.6%, 57.1%, and 54.6% in the first, second, third, and fourth quartiles, respectively (P(categorical)<0.0001). In Cox Proportional Hazard analyses, B-type natriuretic peptide levels, C-reactive protein levels, and left atrial size were associated with arrhythmia recurrence. The diagnosis-to-ablation time had the strongest association with the ablation outcomes which persisted in multivariable Cox analyzes (hazard ratio for recurrence per +1Log diagnosis-to-ablation time 1.27, 95% confidence interval 1.14-1.43; P<0.0001; hazard ratio fourth versus first quartile 2.44, 95% confidence interval 1.68-3.65; P(categorical)<0.0001).
CONCLUSIONS: In patients with PersAF undergoing ablation, the time interval between the first diagnosis of PersAF and the catheter ablation procedure had a strong association with the ablation outcomes, such as shorter diagnosis-to-ablation times were associated with better outcomes and in direct association with markers of atrial remodeling.
© 2016 American Heart Association, Inc.
PMID 26763227 Circ Arrhythm Electrophysiol. 2016 Jan;9(1):e003669. doi: 10.1161/CIRCEP.115.003669.
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