| 엄재선¹ , 심재민¹ , 위진¹ , 문희선¹ , 황혜진¹ , 김종윤² , 정보영¹ , 이문형¹ , 박희남¹ |
Backgrounds: The characteristics and clinical outcome of radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation (AF) associated with structural heart disease (SHD) has not been elucidated thoroughly. We hypothesized that RFCA of AF in patients with SHD results in clinical outcomes comparable to those without SHD. Methods: We included 428 patients with AF (age, 56.0 ± 11.0; male, 77.3%; paroxysmal AF [PAF], 69.4%; persistent AF [PeAF], 30.6%) who underwent RFCA, and compared imaging, hemodynamic or electrophysiologic parameters and clinical outcome between the patients with SHD (n=77, 18.0%) and without SHD (n=351, 82.0%). SHD included coronary artery disease (CAD, 57.1%), valvular heart disease (23.4%), dilated cardiomyopathy (9.1%), hypertrophic cardiomyopathy (7.8%), and congenital heart disease (2.6%). Results: 1. In SHD group, LA diameter (p<0.001), LA volume index (p<0.001), E/E’ (p<0.001), mean LA pressure (p=0.003), effective refractory period (ERP: p=0.027), and plasma levels of ANP (p=0.005) were significantly higher than no-SHD group. The incidences of sinus node dysfunction were 10.4% vs. 11.7% in SHD group and no-SHD group, respectively. 2. In patients with CAD (n=44), there were no significant differences in terms of culprit vessels or number of coronary lesions. 3. There were no significant differences of procedure-related complications (2.6% vs. 3.7%), and the clinical recurrence rates after 3-month blanking period were 21.1% (28.6% with anti-arrhythmic drug [AAD]) vs. 20.2% (20.2% with AAD) in SHD group and no-SHD group, respectively (p=0.859) during 12.7 ± 5.9 months follow-up. Conclusion: RFCA of AF in patients with selected SHD results in comparable peri-procedural and clinical recurrence rates compared with those without SHD, in spite of more advanced LA remodeling, diastolic dysfunction, and hemodynamic overloading.
|
|
|
LAD |
E/E’ |
LAVi |
mLAP |
ERP |
ANP |
|
SHD(-) |
41±6 |
10±3 |
63±20 |
14±5 |
252±42 |
2.2±2.3 |
|
SHD(+) |
44±7 |
13±7 |
78±20 |
18±6 |
267±44 |
3.2±2.9 |
|
p-Value |
<0.001 |
<0.001 |
<0.001 |
0.004 |
0.027 |
0.005 |
|
CAD(-) |
41±6 |
10±4 |
65±20 |
14±6 |
254±43 |
2.3±2.3 |
|
CAD(+) |
44±7 |
12±5 |
76±21 |
18±5 |
264±41 |
3.4±3.2 |
|
p-Value |
0.004 |
0.015 |
0.004 |
0.028 |
0.204 |
0.01 |
LAD, LA diameter; LAVi, LA volume index; mLAP, mean LA pressure
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