Procena uspeha radiofrekventne ablacije plućnih vena u lečenju bolesnika sa paroksizmalnom i perzistentnom atrijalnom fibrilacijom i određivanje prediktora recidiva aritmije nakon pet godina praćenja

Abstract

Cilj: Ova studija je imala za cilj da primeni novu semikvantitativnu meru za procenu ishoda radiofrekventne ablacije (RFA) plućnih vena (PV) koja je nazvana Pulmonary Vein Isolation Outcome Degree (PVIOD), kao i da odredi kliničke parameter koji su udruženi sa PVIOD. Metod: Prosečno vreme praćenja 117 bolesnika posle prve RFA atrijalne fibrilacije (AF) bilo je 83±10 meseca (7 godina) i posle poslednje ablacije 64±22 meseca (5 godina). PVIOD 1 je imalo 32.5% pacijenata sa uspešnom prvom RFA PV, PVIOD 2 je obuhvatio 29.1% bolesnika koji su imali više uspešnih kateterskih ablacija, PVIOD 3 je imalo 14.5% pacijenata sa kliničkim uspehom i PVIOD 4 je obuhvatio 23.9% ispitanika sa proceduralnim i kliničkim neuspehom. Rezultati: Multivarijantna ordinalna logistička regresija je dokazala značajan nezavisan odnos između PVIOD 1–4 i longstanding perzistentne AF sa paraksizmalnom AF kao referentnom kategorijom (odds ratio (OR), 3.5; 95% confidence interval (95% CI), 1.1–10.7 (p = 0.031)), dijametra leve pretkomore (LP) (OR, 1.2; 95% CI, 1.1–1.3 (p = 0.001)) i ejekcione frakcije leve komore (LVEF) (OR, 0.9; 95% CI, 0.86–1.0 (p = 0.038)). Kaplan-Meier krive pokazuju značajnu razliku u preživljavanju bolesnika bez recidiva AF nakon RFA plućnih vena (PVIOD 1 + 2 + 3 u odnosu na PVIOD 4) kada se podele u tri grupe prema tipu AF (long-rank = 9.256, p = 0.01) i dve grupe sa dijametrom LP ≤ 41mm i dijametrom LP > 41 mm (long-rank = 13.808, p ˂ 0.001); LVEF ≤ 50% i LVEF ≥ 50% (long-rank = 9.048, p = 0.003); CHA2DS2-VASc skor 0-1 i 2-5 (long-rank = 6.232, p = 0.013) Zaključak. PVIOD 1–4 omogućava najtačniju dugoročnu prognozu RFA plućnih vena. Svrha ovog rada je i da podstakne upotrebu kvantitativne metode za merenje proceduralnog uspeha u drugim poljima medicinskih i bioloških nauka.

Aim: This study introduces the Pulmonary Vein Isolation Outcome Degree (PVIOD) as a new semiquantitative measure for the efficacy of radiofrequency ablation (RFA) of atrial fibrillation (AF) and reports the determination of predictors associated with PVIOD. Method: The mean follow-up periods of 117 patients after the first and last ablation were, respectively, 83±10 months (7 years) and 64±22 months (5 years). PVIOD 1 included 32.5% of patients, those with successful single RFA of pulmonary vein; PVIOD 2 included 29.1% of subjects, those with success after multiple procedures; PVIOD 3 comprised 14.5% of patients, those with clinical success; and PVIOD 4 included 23.9% of cases, those with procedural and clinical failure. Results: In the multivariate ordinal logistic regression analysis, PVIOD 1–4 were independently associated with longstanding persistent AF with paroxysmal AF as the referent category (odds ratio (OR), 3.5; 95% confidence interval (95% CI), 1.1–10.7 (p = 0.031)), left atrial (LA) diameter (OR, 1.2; 95% CI, 1.1–1.3 (p = 0.001)) and left ventricular ejection fraction (LVEF) (OR, 0.9; 95% CI, 0.86–1.0 (p = 0.038)). The Kaplan-Meier curves showed AF-free survival after RFA (PVIOD 1 + 2 + 3 compared with PVIOD 4) in patients as follows: divided into three groups according to AF type (long-rank = 9.256, p = 0.01) and divided into two groups with LA diameter ≤ 41mm and LA diameter > 41 mm (long-rank = 13.808, p ˂ 0.001); with LVEF ≤ 50% and ≥ 50% (long-rank = 9.048, p = 0.003); with CHA2DS2-VASc scor 0-1 and 2-5 (long-rank = 6.232, p = 0.013). Conclusion. PVIOD 1–4 offer the most exact long-term prognosis of PVI. The purpose of the present article is also to expand the quantitative measure of procedural success in the medical and biological fields.