Persistent Atrial Fibrillation Phenotypes and Ablation Outcomes: Persistent From Outset vs Progression From Paroxysmal AF.

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2024-09-27 DOI:10.1016/j.jacep.2024.09.018

Rose Crowley, David Chieng, Louise Segan, Jeremy William, Hariharan Sugumar, Sandeep Prabhu, Aleksandr Voskoboinik, Liang-Han Ling, Joseph B Morton, Geoffrey Lee, Alex J McLellan, Michael Wong, Rajeev K Pathak, Laurence Sterns, Matthew Ginks, Prashanthan Sanders, Peter M Kistler, Jonathan M Kalman

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引用次数: 0

Abstract

Background: Many patients with persistent atrial fibrillation (PsAF) have progressed from an initial paroxysmal phenotype; however, there are patients in whom atrial fibrillation (AF) is persistent at diagnosis. Relatively little is known about this subgroup, but prior observational studies have suggested these patients have worse outcomes with ablation.

Objectives: This study sought to: 1) assess demographic and electrophysiologic characteristics of patients with PsAF at first diagnosis compared with those with who have progressed from paroxysmal atrial fibrillation (PAF); and 2) assess the impact of pattern of AF at diagnosis on recurrence post ablation.

Methods: CAPLA (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]) was a multicenter trial that randomized patients with PsAF to PVI plus PWI or PVI alone. Follow-up was 12 months. Outcomes were assessed after a 3-month blanking period.

Results: A total of 334 patients were included (median age 65.6 years, 23.1% female), 194 (58.1%) had PsAF at first AF diagnosis and 140 (41.9%) had PAF. Patients with PsAF at diagnosis were younger (age 64.0 vs 67.7 years, P = 0.005), had higher rates of heart failure (P < 0.001), and lower left ventricular ejection fraction (54.5% IQR: 40-60 vs 60% IQR: 50-61, P = 0.007). AF recurrence occurred in 85 (43.8%) with PsAF at diagnosis and 70 (50%) with PAF at diagnosis. PsAF at diagnosis was not associated with risk of recurrence on univariable (HR: 0.802; 95% CI: 0.585-1.101; P = 0.173) or multivariable analysis (HR: 0.922; 95% CI: 0.647-1.312; P = 0.650). Median AF burden was 0% in both groups (P = 0.125). There was no difference in left atrial size (P = 0.337) or bipolar voltage (P = 0.579) between the groups.

Conclusions: In the CAPLA cohort of patients, pattern of AF at first diagnosis did not influence post-ablation rate of AF recurrence or AF burden. (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]; ACTRN12616001436460).

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持续性心房颤动表型与消融结果：持续性心房颤动与阵发性心房颤动的进展。

背景：许多持续性心房颤动（PsAF）患者都是从最初的阵发性表型发展而来；然而，也有一些患者在诊断时心房颤动（AF）就是持续性的。对这一亚群的了解相对较少，但之前的观察性研究表明，这些患者的消融治疗效果较差：本研究旨在目的：本研究旨在：1）评估与阵发性心房颤动（PAF）进展期患者相比，首次诊断为阵发性心房颤动（PsAF）患者的人口统计学和电生理学特征；2）评估诊断时的心房颤动模式对消融术后复发的影响：CAPLA（针对持续性心房颤动的导管消融术：方法：CAPLA（针对持续性房颤的导管消融：肺静脉隔离[PVI] vs PVI与左心房后壁隔离[PWI]的多中心随机试验）是一项多中心试验，将PsAF患者随机分为PVI加PWI或单纯PVI。随访时间为 12 个月。结果：共纳入 334 名患者（中位年龄 65.6 岁，23.1% 为女性），其中 194 人（58.1%）在首次诊断房颤时患有 PsAF，140 人（41.9%）患有 PAF。诊断时患有 PsAF 的患者更年轻（64.0 岁 vs 67.7 岁，P = 0.005），心衰发生率更高（P < 0.001），左室射血分数更低（54.5% IQR：40-60 vs 60% IQR：50-61，P = 0.007）。85例（43.8%）诊断时为PsAF，70例（50%）诊断时为PAF的患者出现房颤复发。诊断时的 PsAF 与单变量分析（HR：0.802；95% CI：0.585-1.101；P = 0.173）或多变量分析（HR：0.922；95% CI：0.647-1.312；P = 0.650）的复发风险无关。两组的中位房颤负荷均为 0%（P = 0.125）。两组患者的左心房大小（P = 0.337）或双极电压（P = 0.579）没有差异：结论：在 CAPLA 患者队列中，首次诊断时的房颤模式不会影响消融后的房颤复发率或房颤负荷。(持续性房颤的导管消融术：肺静脉隔离[PVI]与左心房后壁隔离[PWI]的多中心随机试验；ACTRN12616001436460）。

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

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.