Scripties UMCG - Rijksuniversiteit Groningen
 
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Voorspellers van recidief atrium fibrilleren een (1) een twee jaar post pulmonale vene isolatie

(2016) Noppe, L.J.

Introduction: Pulmonary vein isolation (PVI) is a treatment of atrial fibrillation (AF) that is playing an increasingly bigger role in the treatment of AF. Although the efficacy is quite good many patients will eventually get a recurrence of their AF. This study aims to identify the parameters that may predict the recurrence of AF after 12 and 24 months. Also we tried to identify differences in predictors between both of these follow up periods. With this information combined with other studies we may be able to give better advice in the decision making of the treatment of AF.
Materials and methods: Data of patients that have been treated with PVI in the period 2011-2014 in the MCL for AF were analyzed. Follow up took place after 3 months, after 12 months and after 24 months. In case of recurrence of AF symptoms patients were asked to make an appointment their cardiologist. Of all patient the duration from PVI untill the first recurrence of AF was noted. When there was no recurrence the duration from PVI till the last follow up was noted. All parameters were analyzed using the univariate Cox’s regression model. Significant parameters (p<0.05) from the univariate model were tested together in the multivariate Cox regression model. This was done for both the 12 month as for the 24 month follow up. Significant parameters (p<0.05) from the multivariate analysis were considered as significant predictors for recurrence of AF after PVI.
Results:241 patients (62 ± 9.9 years, 160 males) who were treated with PVI for AF were included in this study. Patients were followed with a median follow up of 22 ± 8.6 months. 12 months after PVI 71.7% of the patients were still free of AF. 24 months after PVI this was 45.6%. A number of parameters were significant in the multivariate Cox regression analysis. For the 12 months follow up the following parameters were significant: Structural heart disease (HR 2.94, p =0.003), AF in blanking period (HR 3.56, p=0.000) and less than 3 pulmonary veins isolated (HR 4.22, p=0.022). For the 24 months follow up the following parameters were significant: Structural heart disease (HR 2.85, p=0.002), AF in blanking period (HR 3.05, p=0.000) and obstructive sleep apnea syndrome (OSAS) (HR 2.73, p=0.038).
Conclusion: The one-year and two-year success of the treatment of AF with PVI was 71.7% and 45.6%, respectively. Structural heart disease, AF in blanking period, OSAS and the number of isolated veins were the best predictors of recurrence of AF after treatment with PVI. The number of isolated veins mainly had an impact within 12 months after PVI where OSAS seemed to have had a bigger impact on the longer term of 24 months after PVI.





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