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.