Abstract:
OBJECTIVES:The purpose of this study was to determine the long-term clinical outcomes of catheter ablation of atrial fibrillation (AF) substrate for high-risk patients with AF. BACKGROUND:The benefits of catheter ablation for high-risk AF patients with respect to mortality and stroke reductions remain unclear. METHODS:We performed AF substrate ablation guided by complex fractionated atrial electrogram (CFAE) mapping in 674 high-risk AF patients. The clinical end points were sinus rhythm (SR), death, stroke, or bleeding. Of these 674 patients, 635 were available for follow-up and made up the study cohort. The patients were relatively old (mean age 67 +/- 12 years) and 129 had an ejection fraction (EF) <40%. RESULTS:After the mean follow-up period of 836 +/- 605 days, 517 were in SR (81.4%). There were 15 deaths among the patients who stayed in SR compared with 14 deaths among those who remained in AF (5-year survival rate, 92% vs. 64%, respectively; p < 0.0001). SR was the most important independent favorable parameter for survival (hazard ratio 0.14, 95% confidence interval 0.06 to 0.36, p < 0.0001), whereas old age was unfavorable. Warfarin therapy was discontinued in 434 of the 517 patients in SR post-ablation (84%) whose annual stroke rate was only 0.4% compared with 2% in those with continuing warfarin treatment (p = 0.004). CONCLUSIONS:CFAE-targeted ablation of AF is effective in maintaining SR in selected high-risk AF patients and might allow patients to stop warfarin therapy. SR after AF ablation is a marker of relatively low mortality and stroke risk. Our findings support conducting further randomized studies to determine whether AF ablation is associated with mortality and/or stroke reduction.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Nademanee K,Schwab MC,Kosar EM,Karwecki M,Moran MD,Visessook N,Michael AD,Ngarmukos Tdoi
10.1016/j.jacc.2007.10.044subject
Has Abstractpub_date
2008-02-26 00:00:00pages
843-9issue
8eissn
0735-1097issn
1558-3597pii
S0735-1097(07)03783-7journal_volume
51pub_type
杂志文章abstract::Knowledge of the pathobiology of pulmonary hypertension (PH) continues to accelerate. However, fundamental gaps remain in our understanding of the underlying pathological changes in pulmonary arteries and veins in the different forms of this syndrome. Although PH primarily affects the arteries, venous disease is incre...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
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更新日期:2013-12-24 00:00:00
abstract:OBJECTIVES:The goal of this study was to evaluate the effect of smoking on the pharmacokinetics and pharmacodynamics (PD) of clopidogrel and prasugrel therapy. BACKGROUND:Major randomized trial data demonstrated that nonsmokers experience less or no benefit from clopidogrel treatment compared with smokers (i.e., the "...
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journal_title:Journal of the American College of Cardiology
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更新日期:2007-03-27 00:00:00
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
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doi:10.1016/s0735-1097(02)01805-3
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abstract:OBJECTIVE:The goal of this study was to determine whether wall stress at rest and during stress could explain the influence of left ventricular (LV) morphology on the accuracy of dobutamine stress echocardiography (DSE). BACKGROUND:The sensitivity of DSE appears to be reduced in patients with concentric remodeling, bu...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(02)02105-8
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abstract::The feasibility of in vivo coronary angioscopy was tested utilizing a 1.8 mm angioscope in vessels where blood had been replaced by optically clear liquids, including a new perfluorocarbon emulsion. After trials in postmortem canine and human coronary arteries, in vivo intraluminal visualization was accomplished in th...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(83)80145-4
更新日期:1983-05-01 00:00:00
abstract::Recent trials have shown that recombinant tissue plasminogen activator (rt-PA) is an effective thrombolytic agent in patients with acute myocardial infarction. Because rt-PA converts plasminogen to plasmin, which is known to activate complement in vitro, we tested the hypothesis that rt-PA can induce in vivo activatio...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80206-1
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更新日期:2009-11-10 00:00:00
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.09.060
更新日期:2006-02-21 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:2005-08-02 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(89)90441-5
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(88)90172-6
更新日期:1988-01-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(90)90594-f
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2007.10.064
更新日期:2008-04-01 00:00:00
abstract::To determine the incidence of cardioversion-induced ventricular arrhythmias in patients with therapeutic serum levels of digoxin, 19 patients (average age [+/- standard deviation] 61 +/- 12 years) undergoing elective direct current cardioversion for atrial fibrillation were studied. Only patients with therapeutic seru...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(85)80427-7
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更新日期:1994-08-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:1998-11-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(85)80207-2
更新日期:1985-12-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80123-7
更新日期:1987-12-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(89)90352-5
更新日期:1989-06-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(94)90423-5
更新日期:1994-02-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)00872-x
更新日期:2000-10-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to compare the effectiveness of the implantable cardioverter defibrillator (ICD) and medical strategies for prevention of arrhythmic events and death. BACKGROUND:The ICD is a potential strategy to reduce mortality in patients at risk of sudden death. METHODS:The MEDLINE, EMBASE, a...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,meta分析
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更新日期:2003-05-07 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(96)00255-0
更新日期:1996-10-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
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更新日期:2012-10-16 00:00:00