PVI-only is not enough for all patients with persistent AF: A FLOW-AF subgroup analysis.

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2024-10-22 DOI:10.1016/j.hrthm.2024.10.037

Atul Verma, Steven Castellano, Melissa H Kong, Petr Neuzil, Tamas Szili-Torok, Stefan G Spitzer, Andreas Rillig, Vivek Y Reddy

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引用次数: 0

Abstract

Background: Since the Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II (STAR-AF II), there has been a trend toward pulmonary vein isolation (PVI)-only ablation strategies for persistent atrial fibrillation (PeAF). Electrographic flow (EGF) mapping can identify active sources of atrial fibrillation (AF) and estimate the electrographic flow consistency (EGFC) of wavefront propagation through substrate, revealing functional AF mechanisms.

Objective: We sought to examine the success of a PVI-only ablation strategy for a redo PeAF/longstanding PeAF population.

Methods: Electrographic Flow-Guided Ablation in Redo Patients With Persistent Atrial Fibrillation (FLOW-AF [NCT04473963]) prospectively enrolled patients with nonparoxysmal AF undergoing redo ablation at 4 centers. One-minute EGF recordings using 64-pole basket catheters were obtained both pre-PVI and post-PVI following a 20-minute wait and confirmation of electrical isolation of veins. Patients with EGF-identified sources were randomized 1:1 to EGF-guided source ablation vs PVI-only. Patients with no sources were not randomized and mostly received PVI only.

Results: Study of 85 patients enrolled 24 with EGF-identified sources randomized to PVI only and 23 with no sources receiving PVI only. Of these 47 patients, those with sources (Group 2) had different clinical characteristics including older age and higher CHA₂DS₂-VASc scores compared with those with no sources (Group 1). After PVI only, Group 1 had 70% (16 of 23) freedom from recurrent AF (FFAF) within 1 year vs Group 2 with 35% (8 of 23), P = .018. In addition, patients with high electrographic flow consistency (EGFC) indicative of healthy or normal substrate had 67% (10 of 15) FFAF vs 45% (14 of 31) in those with low EGFC suggestive of abnormal substrate, P = .011.

Conclusion: Success rates in no-sources patients receiving PVI only are better than in those with sources randomized to PVI only. For the clinically heterogenous population of patients with PeAF, the presence of EGF-identified sources matters clinically, and PVI only will not be enough for all patients.

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仅进行 PVI 对所有持续性房颤患者都不够：FLOW-AF 亚组分析

背景：自 STAR-AF II 试验以来，针对持续性心房颤动（PeAF）的消融策略趋向于仅进行肺静脉隔离（PVI）。电图血流（EGF）绘图可确定房颤的活动源，并估算波前通过基底传播的电图血流一致性（EGFC），从而揭示功能性房颤机制：目的：研究针对重做的 PeAF/长期存在的 PeAF 患者采用纯 PVI 消融策略的成功率：FLOW-AF (NCT04473963)前瞻性地招募了在 4 个中心接受重做消融术的非阵发性房颤患者。在等待 20 分钟并确认静脉电隔离后，在 PVI 前和 PVI 后使用 64 极篮筐导管进行一分钟 EGF 记录。EGF确定了病源的患者按1:1随机分配到EGF引导的病源消融术与单纯PVI。无病源的患者未被随机分配，大多只接受纯 PVI：85 名患者参加了研究：24 名有 EGF 识别来源的患者随机接受纯 PVI，23 名没有来源的患者接受纯 PVI。在这 47 名患者中，与有病源的患者（第 1 组）相比，有病源的患者（第 2 组）具有不同的临床特征，包括年龄较大和 CHA2DS2-VASc 较高。单纯 PVI 治疗后，第 1 组患者一年内不再复发房颤（FFAF）的比例为 70%（16/23），而第 2 组为 35%（8/23），P=0.018。此外，电图血流一致性（EGFC）高表明基质健康或正常的患者一年内无复发房颤（FFAF）的比例为 67%（10/15），而电图血流一致性低表明基质异常的患者一年内无复发房颤（FFAF）的比例为 45%（14/31），P=0.011：结论：接受纯 PVI 治疗的无病源患者的成功率高于随机接受纯 PVI 治疗的有病源患者。对于临床表现各异的 PeAF 患者，EGF 识别来源的存在在临床上很重要，仅 PVI 不能满足所有患者的需求。

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

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.