Comparison Of Circumferential Pulmonary Vein Isolation And Antiarrhythmic Drug Therapy For Atrial Fibrillation

Objective:This study was designed to determine the clinical efficacy of Circumferential pulmonary vein isolation(CPVI) compared with antiarrhythmic drug therapy (ADT) on sinus rhythm (SR) maintenance, quality of life (QOL)in patients with atrial fibrillation (AF).Methods:From Januany 2006 to Jure 2010,156 patients with AF who underwent CPVI in the Second Hospital of Tian jin Medical University were enrolled in the retrospective study, CPVI group. According to exclusion and inclusion criteria, 275 patients with AF who underwent ADT matched with CPVI group,ADT group. By clinic service telephone and letter, the patients after discharged were followed up.The primary end point was AF recurrence. Time to AF recurrence was compared between the CPVI and ADT groups by the Kaplan-Meier analysis and log-rank test.Cox proportional-hazards model was used to estimate the effect of treatment on AF recurrence, while adjusting for other prognostic factors. From Januany 2009 to Jure 2010,123 patients with atrial fibrillation who were referred to us were divided two groups, CPVI group(n=66) and ADT group(n=57). QOL was assessed by Short Form-36(SF-36) at baseline and 6-month after therapy.Results:1 Until October 2010 Among 29 of the 431 patients with AF were lost to follow-up, the rate of following-up was 93.3%, CPVI group(n=143) and ADT group(n=259). During following-up 82 patients in the CPVI group maintained sinus rhythm(SR),while 63 patients in the ADT group were free from recurrent AF.By log-rank test and Kaplan-Meier analysis,57.3%of patients in the CPVI group and 24.3% of those in the ADT group were no recurrent AF (P<0.001).2 In the ablation group,59 (41.3%) patients discontinued antiarrythmic drugs, amiodarone,(3-Bloker,propafenone,Sotalol 48(33.6%),53(37.1%),17,(11.9%),3(2.1%), respectively. According to clinical efficacy,143 patients who underwent circumferential pulmonary vein isolation were divided into two group, sinus rhythm group and AF recurrence group. More patients in sinus rhythm group discontinued antiarrythmic drugs than in AF recurrence group(P<0.001).3 By the univariate Cox proportional hazard regression, type of AF, AF duration,left atial diameter(LAD), left ventricular end-diastolic diameter(LVDD),left ventricular ejection fraction (LVEF),treatment assignment were associated with SR maintenance.Cox proportional-hazards model revealed AF duration,left atial diameter, treatment assignment were independent predictors of AF recurrences.4 During follow-up 1 patients in ADT group died, while no one died in the CPVI group (P=0.56). cerebrovascular events (0.7%vs.5.0%, P=0.02),hospitalization rate (1.1±0.4vs.1.8±1.5, P<0.001), improved heart function (50.3% vs.28.6%, P<0.001).5 After a mean follow-up of 14.7±5.3 months,41 patients were free from AF without antiarrhythmic drug in CPVI group. Of all 8 subscale measured with SF-36, the scores of physical functioning, role physical, role social, role emotional, vitality mental health and general health were significant improvements in CPVI group (P<0.05), and those of bodily pain, did not change significanfly(P>0.05). In the patients who were free from AF after CPVI, the physical component summary scores (PCS)of SF-36 increased from 227.4±57.0 to 293.4±54.3(P<0.001)and the mental component summary scores (MCS)of the SF-36 increased from 243.8±51.7 to 309.0±58.0(P<0.001).Conclusion:1 Circumferential pulmonary vein isolation is superior to Antiarrhythmic drugs for preventing AF recurrence in patients with atrial fibrillation.2 Circumferential pulmonary vein isolation can reduse antiarrythmic drugs,in particular,in sinus rhythm group.3 By the multivariate Cox proportional hazard regression, AF duration,left atial diameter, treatment assignment were independent predictors of AF recurrence.4 Compared with ADT,CPVI can reduse incidence of cerebrovascular event and hospitalization rate,improve heart function.5 Circumferential pulmonary vein isolation can improve quality of life than Antiarrhythmic drugs in patients with atrial fibrillation. In particular, in patients who were free from AF without antiarrhythmic drug QOL can be significantly improved.