所属 医学部 医学科（東京女子医科大学病院） 職種 特任准教授
|発表タイトル||Comparison of the Efficacy of Thoracic Vein Isolation for Paroxysmal and Persistent Atrial Fibrillation in Patients without Structural Heart Disease|
|発表者・共同発表者||◎江島浩一郎, 逸見隆太, 岩波裕史, 柳下大悟, 庄田守男, 萩原誠久|
|学会抄録||第81回日本循環器学会学術集会 プログラム集 399|
|概要||Background: The guidelines suggest that adjuvant substrate modification in addition to pulmonary vein isolation(PVI) is required for persistent atrial fibrillation(PerAF) assuming that catheter ablation is less successful for PerAF than paroxysmal AF(PAF). To revisit the above assumption, we compared the outcome of the same catheter ablation strategy between PAF and PerAF.Methods and
Results: Two‒hundred and twenty‒five consecutive patients (mean age 60±10 years, 53 PerAF) without structural heart disease underwent catheter ablation of AF by the same strategy using a thoracic vein isolation (circumferential PVI plus superior vena cava isolation) without any adjuvant substrate modification, from February 2013 to February 2016. During 25±10 months of follow‒up after single procedures, 67 (30%) patients had atrial tachyarrhythmia recurrences without anti‒arrhythmic drugs. The patients with PerAF were younger (p=0.007) and had a greater BNP level (p<0.0001), lower left ventricular ejection fraction (p<0.0001), and greater left atrial volume index (p<0.0001) than those with PAF. A Kaplan‒Meier analysis of the recurrence‒free survival rate revealed no significant difference between the patients with PAF and those with PerAF (Log‒rank, p=0.38). A Cox regression multivariate analysis demonstrated that none of the variables including PerAF were an independent predictor of an atrial tachyarrhythmia recurrence after a single ablation procedure.
Conclusion: In patients without underlying heart disease, the procedural outcome of a thoracic vein isolation is comparable for PAF and PerAF.