未经证实:肺静脉隔离术(PVI)是治疗心房颤动(AF)的标准消融策略。然而,PVI无反应者重复程序的最佳策略仍不清楚.
UNASSIGNED:本研究旨在调查接受重复手术的患者中PVI无应答者的发生率,以及重复消融复发的预测因素。
UNASSIGNED:共筛查了2016年8月至2019年7月在两个中心接受重复消融的276例连续患者。共纳入64例(22%)持续性PVI患者。技术,如低压区修改,线性消融,非肺静脉触发消融,并进行了上腔静脉(SVC)的经验性隔离。
未经评估:在20.0±9.9个月的随访后,42例(65.6%)患者无房性心律失常。据报道,非阵发性房颤的复发和非复发组之间存在显着差异(50vs.23.8%,p=0.038),糖尿病(27.3vs.4.8%,p=0.02),和经验上腔静脉(SVC)隔离(28.6vs.60.5%,p=0.019)。多因素回归分析表明,经验SVC隔离是无复发的独立预测因素(95%CI:1.64-32.8,p=0.009)。Kaplan-Meier曲线显示经验性和非经验性SVC隔离组之间复发的显着差异(HR:0.338;95%CI:0.131-0.873;p=0.025)。
UNASSIGNED:重复手术中大约22%的患者是PVI无应答者。非阵发性房颤和糖尿病与再消融后复发相关。经验SVC分离可能会改善PVI无反应者重复程序的结果。
UNASSIGNED: Pulmonary vein isolation (PVI) is the standard ablation strategy for treating atrial fibrillation (AF). However, the optimal strategy of a repeat procedure for PVI non-responders remains unclear.
UNASSIGNED: This study aims to investigate the incidence of PVI non-responders in patients undergoing a repeat procedure, as well as the predictors for the recurrence of repeat ablation.
UNASSIGNED: A total of 276 consecutive patients who underwent repeat ablation from August 2016 to July 2019 in two centers were screened. A total of 64 (22%) patients with durable PVI were enrolled. Techniques such as low voltage zone modification, linear ablation, non-PV trigger ablation, and empirical superior vena cava (SVC) isolation were conducted.
UNASSIGNED: After the 20.0 ± 9.9 month follow-up, 42 (65.6%) patients were free from atrial arrhythmias. A significant difference was reported between the recurrent and non-recurrent groups in non-paroxysmal AF (50 vs. 23.8%, p = 0.038), diabetes mellitus (27.3 vs. 4.8%, p = 0.02), and empirical superior vena cava (SVC) isolation (28.6 vs. 60.5%, p = 0.019). Multivariate regression analysis demonstrated that empirical SVC isolation was an independent predictor of freedom from recurrence (95% CI: 1.64-32.8, p = 0.009). Kaplan-Meier curve demonstrates significant difference in recurrence between empirical and non-empirical SVC isolation groups (HR: 0.338; 95% CI: 0.131-0.873; p = 0.025).
UNASSIGNED: About 22% of patients in repeat procedures were PVI non-responders. Non-paroxysmal AF and diabetes mellitus were associated with recurrence post-re-ablation. Empirical SVC isolation could potentially improve the outcome of repeat procedures in PVI non-responders.