Prognostic Value of Burst Pacing Inducibility Post-Radiofrequency Versus Cryoablation for Paroxysmal Atrial Fibrillation.

IF 1.7 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Pace-Pacing and Clinical Electrophysiology Pub Date : 2024-10-15 DOI:10.1111/pace.15092

Satoru Sekimoto, Kenta Hachiya, Taku Ichihashi, Takayuki Yoshida, Yasuaki Wada, Yoshimasa Murakami, Yoshihiro Seo

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引用次数: 0

Abstract

Background: Atrial fibrillation (AF) inducibility with burst pacing (BP) after radiofrequency ablation (RFA) has been reported to be associated with AF recurrence. In contrast, the relevance of inducibility and recurrence after cryoablation (CRA) is unclear.

Methods: We investigated 367 patients undergoing initial ablation for paroxysmal AF (RFA: 174, CRA: 193). Propensity score matching was conducted, retaining 134 patients in each group. Following pulmonary vein isolation (PVI), the inducibility by BP was tested. Inductions at 250 ppm were defined as low-frequency burst pacing (LFBP) positive, and those at 300 ppm were classified as medium-frequency burst pacing (MFBP) positive. They were followed for 600 days.

Results: Forty-eight patients (18%) had AF recurrence. There was no significant difference in the recurrence rate between RFA and CRA (17% vs. 19%, Log-rank p = 0.79). In RFA, significant differences were observed for both LFBP (Log-rank p < 0.001) and MFBP (Log-rank p < 0.001). In contrast, in CRA, there were no significant differences for either LFBP (Log-rank p = 0.39) or MFBP (Log-rank p = 0.19). Multivariable analysis revealed that LFBP-positive (hazards ratio [HR] = 5.75, 95% confidence interval [CI] 2.41-13.7, p < 0.001) was an independent predictor for recurrence with RFA. Acute reconnection (HR = 2.73, 95% CI 1.13-6.56, p = 0.025) was an independent predictor for recurrence with CRA.

Conclusion: The inducibility by BP after RFA predicted recurrence at both low and medium frequencies. LFBP-positive was an independent predictor of recurrence in multivariable analysis. In contrast, the inducibility by BP after CRA was not a predictor of recurrence.

Trail registration: This study did not require clinical trial registration.

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射频与低温消融术治疗阵发性心房颤动后脉冲起搏诱导性的预后价值

背景：据报道，射频消融术（RFA）后使用脉冲起搏（BP）诱导房颤（AF）与房颤复发有关。相比之下，低温消融术（CRA）后诱导性与复发的相关性尚不清楚：我们调查了 367 例因阵发性房颤接受初次消融术的患者（RFA：174 例，CRA：193 例）。进行了倾向评分匹配，每组保留了 134 名患者。肺静脉隔离（PVI）后，测试了血压的诱导性。250 ppm的诱导被定义为低频猝发起搏（LFBP）阳性，300 ppm的诱导被定义为中频猝发起搏（MFBP）阳性。对他们进行了 600 天的随访：结果：48 名患者（18%）房颤复发。RFA 和 CRA 的复发率无明显差异（17% 对 19%，Log-rank p = 0.79）。在 RFA 中，LFBP 和 CRA 的复发率均有显著差异（Log-rank p = 0.79）：RFA 后 BP 的诱导性可预测低频和中频的复发。在多变量分析中，LFBP 阳性是复发的独立预测因素。相比之下，CRA后BP的诱导性并不能预测复发：本研究无需进行临床试验注册。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pace-Pacing and Clinical Electrophysiology 医学-工程：生物医学

CiteScore

2.70

自引率

5.60%

发文量

209

审稿时长

2-4 weeks

期刊介绍： Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.