Long-term outcomes of catheter ablation of atrial fibrillation in dilated cardiomyopathy

被引:14
作者
Zhao, Liang [1 ]
Xu, Kai [1 ]
Jiang, Weifeng [1 ]
Zhou, Li [1 ]
Wang, Yuanlong [1 ]
Zhang, Xiaodong [1 ]
Wu, Shaohui [1 ]
Liu, Xu [1 ]
机构
[1] Shanghai Jiao Tong Univ, Shanghai Chest Hosp, Shanghai, Peoples R China
关键词
Atrial fibrillation; Catheter ablation; Dilated cardiomyopathy; AMERICAN-HEART-ASSOCIATION; PROGNOSTIC-SIGNIFICANCE; TASK-FORCE; FAILURE; CARDIOLOGY; TRIAL; CLASSIFICATION; DEFINITIONS; MECHANISMS; MANAGEMENT;
D O I
10.1016/j.ijcard.2015.04.186
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: The long-term outcomes, efficacy and safety of catheter ablation in atrial fibrillation (AF) patients with dilated cardiomyopathy (DCM) have not been reported previously. Methods and results: Forty nine patients with AF (59% longstanding persistent AF, LSP-AF) and DCM were enrolled. Circumferential pulmonary vein ablation (CPVA, paroxysmal AF), bidirectional block of lines and disappearance of complex fractionated atrial electrograms (CFAEs, persistent and LSP-AF) were the endpoints of the index and repeat procedures. Cumulative success rate reached 49% (mean, 1.4 procedures) during the first year, and dropped to 38% at median follow-up of 45 months (range, 36-64 months) for multiple procedures (mean, 1.9 +/- 0.8 [1-4]). Incidence of procedural complications was similar to that of conventional procedures. In multivariate analysis, LSP-AF (OR, 7.40 [95% CI, 1.42-38.34]; P = 0.017) and larger left ventricular enddiastolic diameter (OR, 1.24 [95% CI, 1.01-1.52]; P=0.034) were significant independent predictors of recurrent atrial tachyarrhythmia (ATa). Compared with patients with ATa recurrence, those free from ATa had better New York Heart Association functional class, 6-minute walk distance and left ventricular ejection fraction during long-term follow-up compared with pre-ablation, but this improvement was not sustained beyond 3 years. Conclusion: In patients with DCM, current commonly used ablation strategies including CPVA, linear ablation and CFAE ablation are not associated with long-term AF treatment success up to five years. Freedom from ATa is associated with improved heart failure during but not beyond 3 years post ablation. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:227 / 232
页数:6
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