比较非阵发性心房颤动(NPAF)消融患者逐步入路与左心房后壁隔离(LAPWI)的多次导管消融结果。
在大型临床试验中,逐步消融NPAF的不利结果可能归因于不完整消融线的致心律失常效应。尚不清楚更广泛的初始消融策略是否会在多次消融手术后改善结果。
采用逐步(第1组,n=111)或LAPWI(第2组,n=111)方法,使用接触力传感消融导管对22例连续NPAF患者进行了首次消融。随访时间为36个月。主要终点为无房性心律失常>30s,次要终点为无持续性心律失常,重复消融,和反复消融后的心律失常。
在36个月时,逐步和LAPWI组的指数消融后无房性心律失常的情况相似(60%vs.69%,p=.1)。逐步组更有可能出现持续性复发性心律失常(29%vs.14%,p=.005)和更可能进行第二次导管消融(32%vs.12%,p<.001)与LAPWI患者相比。与LAPWI组相比,逐步组重复消融后复发性心律失常的可能性更大(15%vs.4%,p=.003)。
与逐步方法相比,NPAF患者的LAPWI导致任何房性心律失常的发生率相似,持续性心律失常的发生率较低,和更少的重复消融。使用更广泛的初始方法并没有改善重复消融的结果。
To compare multiple-procedure catheter ablation outcomes of a stepwise approach versus left atrial posterior wall isolation (LA PWI) in patients undergoing nonparoxysmal atrial fibrillation (NPAF) ablation.
Unfavorable outcomes for stepwise ablation of NPAF in large clinical trials may be attributable to proarrhythmic effects of incomplete ablation lines. It is unknown if a more extensive initial ablation strategy results in improved outcomes following multiple ablation procedures.
Two hundred twenty two consecutive patients with NPAF underwent first-time ablation using a contact-force sensing ablation catheter utilizing either a stepwise (Group 1, n = 111) or LA PWI (Group 2, n = 111) approach. The duration of follow-up was 36 months. The primary endpoint was freedom from atrial arrhythmia >30 s. Secondary endpoints were freedom from persistent arrhythmia, repeat ablation, and recurrent arrhythmia after repeat ablation.
There was similar freedom from atrial arrhythmias after index ablation for both stepwise and LA PWI groups at 36 months (60% vs. 69%, p = .1). The stepwise group was more likely to present with persistent recurrent arrhythmia (29% vs. 14%, p = .005) and more likely to undergo second catheter ablation (32% vs. 12%, p < .001) compared to LA PWI patients. Recurrent arrhythmia after repeat ablation was more likely in the stepwise group compared to the LA PWI group (15% vs. 4%, p = .003).
Compared to a stepwise approach, LA PWI for patients with NPAF resulted in a similar incidence of any atrial arrhythmia, lower incidence of persistent arrhythmia, and fewer repeat ablations. Results for repeat ablation were not improved with a more extensive initial approach.