Purpose

Catheter ablation for atrial fibrillation (AF) is a standard procedure for maintaining sinus rhythm. The aim of this study was to evaluate treatment success and its predictors and to provide quality control data on complications and redo operations in a centre with an initially a low but currently high annual volume.

Methods

Data on patients (n = 1,253) treated with catheter ablation for AF in Tays Heart Hospital between January 2010 and May 2018 was evaluated (n = 1178 ablation-naïve patients and n = 1514 AF ablations). Comprehensive data on patient characteristics, treatment results, redo operations and complications were collected. Treatment success (maintenance of sinus rhythm at 1 year) was evaluated among patients residing within the hospital district (45% of the entire study population).

Results

Treatment success was observed in approximately 62.9% of the ablation-naïve patients. Preoperative predictors of treatment success were paroxysmal AF type, previous use of antiarrhythmic drugs, left atrium diameter and age. The experience at the centre did not associate with the 1-year outcome. A relapse during the first 3-month blanking period was associated with a nine-fold risk of failure at 1 year (unadjusted OR 9.1, 95% CI 5.5–15.1, p < 0.001). The major complication rate was 4.5% (68/1514) with no deaths. Ten percent of the patients needed a redo procedure within the first year.

Conclusions

Patient-related factors are the most significant predictors of treatment success. A relapse during a 3-month blanking period is associated with a very high risk of failure at 1 year.

中文翻译：

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高容量中心房颤的治疗成功及其预测因素以及导管消融术的并发症

目的

心房颤动 (AF) 的导管消融是维持窦性心律的标准程序。本研究的目的是评估治疗成功及其预测因素，并提供有关并发症和重做手术的质量控制数据，该中心的年手术量最初较低，但目前较高。

方法

 评估了 2010 年 1 月至 2018 年 5 月期间在 Tays 心脏病医院接受导管消融治疗的 AF患者（n = 1,253）的数据（ n  = 1178 名未接受消融的患者和n  = 1514 名 AF 消融）。收集了有关患者特征、治疗结果、重做手术和并发症的综合数据。在居住在医院区内的患者（占整个研究人群的 45%）中评估了治疗成功（1 年时维持窦性心律）。

结果

在大约 62.9% 的初治患者中观察到治疗成功。治疗成功的术前预测因素是阵发性房颤类型、既往使用抗心律失常药物、左心房直径和年龄。该中心的经验与 1 年的结果无关。在前 3 个月的空白期复发与 1 年失败风险的九倍相关（未调整的 OR 9.1，95% CI 5.5-15.1，p  < 0.001）。主要并发症发生率为 4.5% (68/1514)，无死亡。百分之十的患者需要在第一年内重做手术。

结论

患者相关因素是治疗成功的最重要预测因素。在 3 个月的空白期内复发与 1 年失败的风险非常高有关。