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Predictive value of premature atrial complex characteristics in pulmonary vein isolation for patients with paroxysmal atrial fibrillation.

[临床试验] 阵发性心房颤动患者肺静脉隔离中房早复征特征的预测价值.

  • 影响因子:2.06
  • DOI:10.1016/j.acvd.2020.09.001
  • 作者列表:"Hamon D","Courty B","Leenhardt A","Lim P","Elbaz N","Rouffiac S","Varlet E","Algalarrondo V","Messali A","Audureau E","Extramiana F","Lellouche N
  • 发表时间:2021-02-01
Abstract

BACKGROUND:Premature atrial complexes from pulmonary veins are the main triggers for atrial fibrillation in the early stages. Thus, pulmonary vein isolation is the cornerstone of catheter ablation for paroxysmal atrial fibrillation. However, the success rate remains perfectible. AIM:To assess whether premature atrial complex characteristics before catheter ablation can predict pulmonary vein isolation success in paroxysmal atrial fibrillation. METHODS:We investigated consecutive patients who underwent catheter ablation for paroxysmal atrial fibrillation from January 2013 to April 2017 in two French centres. Patients were included if they were treated with pulmonary vein isolation alone, and had 24-hour Holter electrocardiogram data before catheter ablation available and a follow-up of≥6 months. Catheter ablation success was defined as freedom from any sustained atrial arrhythmia recurrence after a 3-month blanking period following catheter ablation. RESULTS:One hundred and three patients were included; all had an acute successful pulmonary vein isolation procedure, and 34 (33%) had atrial arrhythmia recurrences during a mean follow-up of 30±15 months (group 1). Patients in group 1 presented a longer history of atrial fibrillation (71.9±65.8 vs. 42.9±48.4 months; P=0.008) compared with those who were "free from arrhythmia" (group 2). Importantly, the daily number of premature atrial complexes before catheter ablation was significantly lower in group 1 (498±1413 vs. 1493±3366 in group 2; P=0.028). A daily premature atrial complex cut-off number of<670 predicted recurrences after pulmonary vein isolation (41.1% vs. 13.3%; sensitivity 88.2%; specificity 37.7%; area under the curve 0.635; P=0.017), and was the only independent predictive criterion in the multivariable analysis (4-fold increased risk). CONCLUSION:Preprocedural premature atrial complex analysis on 24-hour Holter electrocardiogram in paroxysmal atrial fibrillation may improve patient selection for pulmonary vein isolation.

摘要

背景: 来自肺静脉的房早复合物是早期心房颤动的主要诱因。因此,肺静脉隔离是阵发性心房颤动导管消融的基石。然而,成功率仍然是完美的。 目的: 评估导管消融前房早复征是否能预测阵发性心房颤动肺静脉隔离的成功。 方法: 我们调查了2013年1月至2017年4月在法国两个中心接受导管消融治疗阵发性心房颤动的连续患者。如果患者仅接受肺静脉隔离治疗,并且在导管消融前有24小时动态心电图数据,并且随访时间 ≥ 6个月,则纳入患者。导管消融成功被定义为在导管消融后3个月的消隐期后没有任何持续的房性心律失常复发。 结果: 共纳入33% 例患者; 所有患者均获得急性成功的肺静脉隔离手术,34例 () 在平均30 ± 15个月的随访期间复发房性心律失常 (组1)。与 “无心律失常” 的患者 (组2) 相比,组1的患者表现出更长的房颤病史 (71.9 ± 65.8对42.9 ± 48.4个月; P = 0.008)。重要的是,在导管消融前,组1的每日房性早搏数显著降低 (498 ± 1413 vs.组2的1493 ± 3366; P = 0.028)。每日房早复界数 <670预测肺静脉隔离后复发 (41.1% vs. 13.3%; 敏感性88.2%; 特异性37.7%; 曲线下面积0.635; P = 0.017),是多变量分析中唯一的独立预测标准 (风险增加4倍). 结论: 对阵发性心房颤动患者进行24小时动态心电图房性早搏综合分析,可改善肺静脉隔离的患者选择。

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