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Abstract：
OBJECTIVE: The CArdioSurgEry Atrial Fibrillation (CASE-AF) registry is a prospective, multicentre study for collecting and analysing real-world data of surgical atrial fibrillation (AF) treatment. This study aimed to evaluate outcomes of surgery for long-standing persistent AF at 1 year.
METHODS: In total, 17 centres consecutively include all eligible patients with continuous AF lasting for ≥1 year. Exclusion criteria are missing informed consent or age <18 years. For patient-reported outcomes measures, the European Heart Rhythm Association score was used. No presence of AF (based on ECG findings including Holter ECG and/or implanted devices), no re-ablation, no further cardioversion and no rehospitalization due to AF after a 3-month blanking period defined no AF recurrence at 1 year.
RESULTS: From January 2017 to January 2020, a total of 1115 patients were enrolled in CASE-AF. Of them, 202 patients (mean age 69.7 ± 7.8 years, 27.2% female) underwent surgical ablation of long-standing persistent AF (study cohort), mostly accompanied by left atrial appendage closure (n = 180 [89%], resection n = 75 [42%]) and predominantly performed as concomitant (n = 174 [86%]) and left atrial only procedure (n = 144 [71%]). Early mortality (30 days) was 2.0% and morbidity was low. At follow-up (median 14.4 months, interquartile range, 12.7-17.6 months, 100% complete), 106 patients (56%) had no AF recurrence and 93% of them were asymptomatic. AF recurrence was accompanied by AF-related rehospitalization (n = 12, P = 0.003), direct current shock cardioversion (n = 23, P < 0.001), AF ablation (n = 7, P = 0.003) and stroke (n = 3, P = 0.059). Multivariable analysis identified cryoablation, predominantly performed endocardially including additional left atrial (74%) and biatrial (42%) lesions, as a significant factor for freedom from AF recurrence (odds ratio 2.7, 95% confidence interval 1.07-6.79, P = 0.035).
CONCLUSIONS: According to CASE-AF, surgical ablation of long-standing persistent AF is most effective when concomitantly performed using endocardial cryoablation. Ongoing follow-up allows further elucidation of efficacious treatment strategies.
METHODS: In total, 17 centres consecutively include all eligible patients with continuous AF lasting for ≥1 year. Exclusion criteria are missing informed consent or age <18 years. For patient-reported outcomes measures, the European Heart Rhythm Association score was used. No presence of AF (based on ECG findings including Holter ECG and/or implanted devices), no re-ablation, no further cardioversion and no rehospitalization due to AF after a 3-month blanking period defined no AF recurrence at 1 year.
RESULTS: From January 2017 to January 2020, a total of 1115 patients were enrolled in CASE-AF. Of them, 202 patients (mean age 69.7 ± 7.8 years, 27.2% female) underwent surgical ablation of long-standing persistent AF (study cohort), mostly accompanied by left atrial appendage closure (n = 180 [89%], resection n = 75 [42%]) and predominantly performed as concomitant (n = 174 [86%]) and left atrial only procedure (n = 144 [71%]). Early mortality (30 days) was 2.0% and morbidity was low. At follow-up (median 14.4 months, interquartile range, 12.7-17.6 months, 100% complete), 106 patients (56%) had no AF recurrence and 93% of them were asymptomatic. AF recurrence was accompanied by AF-related rehospitalization (n = 12, P = 0.003), direct current shock cardioversion (n = 23, P < 0.001), AF ablation (n = 7, P = 0.003) and stroke (n = 3, P = 0.059). Multivariable analysis identified cryoablation, predominantly performed endocardially including additional left atrial (74%) and biatrial (42%) lesions, as a significant factor for freedom from AF recurrence (odds ratio 2.7, 95% confidence interval 1.07-6.79, P = 0.035).
CONCLUSIONS: According to CASE-AF, surgical ablation of long-standing persistent AF is most effective when concomitantly performed using endocardial cryoablation. Ongoing follow-up allows further elucidation of efficacious treatment strategies.
摘要：
目的：CArdioSurgEry心房颤动（CASE-AF）注册是一个前瞻性的，多中心研究，用于收集和分析外科房颤治疗的真实世界数据。本研究旨在评估长期持续性房颤一年的手术效果。
方法：总共，17个中心连续包括所有符合条件的持续房颤持续≥1年的患者。排除标准是缺少知情同意或年龄<18岁。对于患者报告的结果测量，使用EHRA评分。无房颤(根据心电图检查结果,包括动态心电图和/或植入装置),没有再消融,没有进一步的心脏复律,并且在3个月的消隐期后没有因AF而再次住院，定义了在1年时没有AF复发。
结果：从2017年1月至2020年1月，共有1115例患者纳入CASE-AF。其中,202名患者（平均年龄69.7±7.8岁，27.2%女性)接受长期持续性房颤手术消融术(研究队列),主要伴有左心耳闭合（n=180[89%]，切除n=75[42%]），主要是同时进行（n=174[86%]）和仅左心房手术（n=144[71%]）。早期死亡率（30d）为2.0％，发病率低。随访时(中位数为14.4个月，IQR,12.7-17.6个月，100%完成),106例患者（56%）无房颤复发，其中93%无症状。房颤复发伴随着房颤相关的再次住院(n=12,p=0.003),DC休克复律（n=23，p<0.001），AF消融（n=7，p=0.003），和冲程(n=3,p=0.059)。多变量分析确定冷冻消融，主要在心内进行，包括额外的左心房（74％）和双心房（42％）病变，作为无房颤复发的重要因素(比值比2.7,95%置信区间1.07-6.79,p=0.035).
结论：根据CASE-AF，同时使用心内膜冷冻消融术时,LSPAF的手术消融术最有效.持续的随访可以进一步阐明有效的治疗策略。
背景：CASE-AF注册表，ClinicalTrials.gov,NCT03091452，注册于2017年3月27日。
方法：总共，17个中心连续包括所有符合条件的持续房颤持续≥1年的患者。排除标准是缺少知情同意或年龄<18岁。对于患者报告的结果测量，使用EHRA评分。无房颤(根据心电图检查结果,包括动态心电图和/或植入装置),没有再消融,没有进一步的心脏复律,并且在3个月的消隐期后没有因AF而再次住院，定义了在1年时没有AF复发。
结果：从2017年1月至2020年1月，共有1115例患者纳入CASE-AF。其中,202名患者（平均年龄69.7±7.8岁，27.2%女性)接受长期持续性房颤手术消融术(研究队列),主要伴有左心耳闭合（n=180[89%]，切除n=75[42%]），主要是同时进行（n=174[86%]）和仅左心房手术（n=144[71%]）。早期死亡率（30d）为2.0％，发病率低。随访时(中位数为14.4个月，IQR,12.7-17.6个月，100%完成),106例患者（56%）无房颤复发，其中93%无症状。房颤复发伴随着房颤相关的再次住院(n=12,p=0.003),DC休克复律（n=23，p<0.001），AF消融（n=7，p=0.003），和冲程(n=3,p=0.059)。多变量分析确定冷冻消融，主要在心内进行，包括额外的左心房（74％）和双心房（42％）病变，作为无房颤复发的重要因素(比值比2.7,95%置信区间1.07-6.79,p=0.035).
结论：根据CASE-AF，同时使用心内膜冷冻消融术时,LSPAF的手术消融术最有效.持续的随访可以进一步阐明有效的治疗策略。
背景：CASE-AF注册表，ClinicalTrials.gov,NCT03091452，注册于2017年3月27日。
