背景:由于持续性心房颤动(AF)的成功率不佳,导管消融(CA)仍然具有挑战性。现有的映射技术不能可靠地区分该患者群体中的来源。最近,使用改进的Horn-Schunk光流算法开发了新型的电描记图流(EGF)标测系统,以检测和量化心房中电波前传播的模式。
目的:验证基于EGF映射的靶向源消融优于经验性AF消融的假设。
方法:我们纳入了所有连续接受EGF引导消融治疗持续性房颤的患者。所有患者均接受了肺静脉隔离术(PVI),并使用相同的EAM系统(CARTO)进行治疗。将PVIEGF指导的CA的结果与仅PVI手术(仅PVI组)和PVI加上其他经验性辅助线性和基底消融(PVILINES组)的数据进行比较。12个月无房颤和房性心动过速/扑动(AT/AFL)以程序持续时间为特征的程序安全性和效率,透视使用,射频应用和持续时间,进行了分析。进行了意向治疗和按方案分析。
结果:总共70例患者(39例PVI+EGF,仅PVI组16例,PVI+LINES组15例)。意向治疗分析显示,在12个月时,与仅PVI或PVI+LINES组相比,PVI+EGF组房颤复发较少(25.6%vs.62.5%与53.3%,p=.02)。AT/AFL复发无差异(17.9%vs.37.5%与20.0%,p=.37)。PVI+EGF组手术时间较长(p<0.01),透视使用无差异(p=0.67).
结论:我们的数据表明,接受EGF引导的CA治疗的患者房颤复发较少。虽然手术时间较长,它似乎是安全的,并提供了一个更有针对性的,在这一复杂的患者组中,除了PVI以外的患者特异性消融策略,而不是辅助经验性消融和基质消融.
Catheter ablation (CA) remains challenging due to suboptimal success rates in persistent atrial fibrillation (AF). Existing mapping technologies cannot reliably distinguish sources in this patient population. Recently, the novel electrographic flow (EGF) mapping system was developed using a modified Horn-Schunk optical flow algorithm to detect and quantify patterns of electrical wavefront propagation in the atria.
To test the hypothesis that targeted source ablation based on EGF mapping is superior to empiric AF ablation.
We included all consecutive patients undergoing EGF guided ablation for persistent AF. All patients underwent pulmonary vein isolation (PVI) and were treated with the same EAM system (CARTO). The outcome of PVI+EGF guided CA was compared with data of PVI-only procedures (PVI-only group) and PVI plus additional empiric adjunctive linear and substrate ablations (PVI+LINES group). 12-months outcome as freedom from AF and atrial tachycardia/flutter (AT/AFL), procedural safety and efficiency characterized by procedure duration, fluoroscopy use, radiofrequency applications and duration, were analyzed. Both intention-to-treat and per protocol analysis were conducted.
A total number of 70 patients (39 in PVI+EGF, 16 in PVI-only and 15 patients in PVI+LINES group) were enrolled. Intention-to-treat analysis showed fewer AF recurrences in PVI+EGF as compared with the PVI-only or PVI+LINES groups at 12 months (25.6% vs. 62.5% vs. 53.3%, p = .02). There were no differences in AT/AFL recurrence (17.9% vs. 37.5% vs. 20.0%, p = .37). Procedure times were longer in PVI+EGF group (p < .01), and there were no differences in fluoroscopy use (p = .67).
Our data suggest that patients treated with EGF-guided CA developed fewer AF recurrences. Although the procedure times are longer, it seems to be safe and offers a more targeted, patient-specific ablation strategy beyond PVI than adjunctive empiric lines and substrate ablation in this complex group of patients.