Evaluation On The Effects Of Circumferential Pulmonary Vein Isolation And Antiarrhythmic Drug Therapy In Atrial Fibrillation

Objective:This study was designed to evaluate the clinical efficacy between circumferential pulmonary vein isolation (CPVI) and antiarrhythmic drug (AAD) therapy in atrial fibrillation (AF) through constant follow-up.Methods:A total of 100 patients with AF who underwent either CPVI or anti-arrhythmic drug therapy in Huadong Hospital of Fudan University between year 2011 to 2012 were enrolled in this study.50 patients who underwent CPVI were categorized as the ablation group while 50 patients who received AAD therapy were categorized as the drug group. All subjects are patients with paroxysmal atrial fibrillation (PAF). Basic information of the patients were collected. After the patients were discharged from the hospital, they were required to maintain a routine check on electrocardiogram (ECG),24 hours electrocardiogram and echocardiography every 3 months for the first year and every 6 months for the following years. A recurrence of atrial fibrillation is the primary endpoint of this study, which serves to compare the clinical efficacy between CPVI and AAD therapy in AF. SPSS 16.0 software is applied for statistic analysis. Measurement data are expressed as mean±standard deviation (x±s).Comparison between groups is made by applying their respective means through t test or rank-sum test. Enumeration data are expressed as either ratio or percentage. Possible factors of AF recurrence are analyzed by logistic regression analysis. If the value of P<0.05, it means that particular factor has statistical significance. Then evaluate these possible factors by receiver operating characteristic (ROC) curve to determine their respective clinical significance.Results:CVPI were successful for all the patients in the ablation group. The average procedure time was (180±34) minutes. The average fluoroscopy time was (33±18) minutes. Complications such as pulmonary vein stenosis, atrial esophageal fistula, stroke, etc did not occur before and after the procedure. No major adverse events related to the procedures occurred. All patients maintained sinus rhythm and did not show signs of dyspnea, coughing, hemoptysis, etc when they are discharged from the hospital. The follow-up of all the subjects are successful upon the termination of the study. The average of the follow-up duration is (21.72±5.09) months for the ablation group in which 41 cases maintained sinus rhythm,9 cases had AF recurrence. Therefore, the clinical efficacy rate for the ablation group is 82.0%. The average of the follow-up duration was (17.72±6.19) months for the drug group in which 22 cases maintained sinus rhythm,28 cases had AF recurrence. Therefore, the clinical efficacy rate for the drug group is 44.0.%. It showed no difference in sinus rhythm maintenance between the two groups after 6 months upon their discharge from the hospital; however, the ablation group showed superiority in sinus rhythm maintenance after a year. In general, CVPI is a better therapy than AAD for the prevention of AF recurrence.Conclusion:CVPI could dramatically lower the rate of AF recurrence and proven to be superior over AAD therapy in the maintenance of sinus rhythm for patients with AF. Therapeutic options, LAD, the history of AF are the predictors of AF recurrence. The application of statins could help in the prevention of AF recurrence.