Temporary Restoration of Sinus Rhythm Improves Outcomes of Catheter Ablation for Longstanding Persistent Atrial Fibrillation.

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Mohamad Raad, Justice Oranefo, Haran Yogasundaram, Michael I Gurin, Erica Zado, Michelle Walsh, Timothy Markman, Gustavo Guandalini, Matthew C Hyman, Robert Schaller, Ramanan Kumareswaran, Gregory Supple, Rajat Deo, Saman Nazarian, Michael Riley, David Lin, Fermin Garcia, David S Frankel, David Callans, Andrew E Epstein, Francis E Marchlinski, Sanjay Dixit
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引用次数: 0

Abstract

Background: Long-standing persistent atrial fibrillation (LSPAF) is associated with adverse atrial structural and electrical remodeling, limiting the success of catheter ablation (CA).

Objective: To determine whether temporary restoration of sinus rhythm (TRSR) can improve the single procedure efficacy of CA in patients with LSPAF.

Methods: Patients with LSPAF undergoing their first CA between 2016 and 2022 were included. TRSR was attempted using cardioversion, with or without antiarrhythmic drugs (AAD), no later than 6 months before CA. The ablation strategy included pulmonary vein isolation (PVI), non-PV trigger ablation, and linear lesions for organized atrial tachyarrhythmias (OAT). The primary study outcome was freedom from atrial arrhythmias (AA: AF and/or OAT) on/off AAD at 12 months, and the secondary outcome was freedom from AA off AAD at 12 months.

Results: One hundred eighty patients (median age 66 years, 24% female) were included. TRSR was attempted in 67 (37%) patients, and 17 (25%) of these presented in SR at the time of CA. Patients undergoing TRSR had more comorbidities (CHA2DS2-VASc score 3.1 vs. 2.7, p = 0.012) than those who did not. The primary and secondary outcomes were significantly better in the TRSR than the no TRSR group: AA-free survival (73% vs. 51%, p = 0.004) and AA-free survival off AAD (69% vs. 45%, p = 0.002). The primary outcome was better in the TRSR group, whether the presenting rhythm at CA was SR or AF (75% and 72%, respectively).

Conclusions: TRSR within 6 months of CA was associated with improved arrhythmia-free survival in LSPAF patients undergoing CA regardless of the presenting rhythm at ablation.

暂时恢复窦性心律改善导管消融治疗长期持续性心房颤动的疗效。
背景:长期持续性心房颤动(LSPAF)与不良的心房结构和电重构相关,限制了导管消融(CA)的成功。目的:探讨暂时恢复窦性心律(TRSR)是否能提高LSPAF患者单次CA的疗效。方法:纳入2016年至2022年间首次行CA的LSPAF患者。在CA发生前不迟于6个月,使用心律转复,联合或不联合抗心律失常药物(AAD)尝试TRSR。消融策略包括肺静脉隔离(PVI)、非pv触发消融和线状病变治疗有组织性房性心动过速(OAT)。主要研究结果是12个月时在AAD时无房性心律失常(AA: AF和/或OAT),次要结果是12个月时在AAD时无房性心律失常。结果:纳入180例患者(中位年龄66岁,24%为女性)。67例(37%)患者尝试了TRSR,其中17例(25%)患者在CA发生时出现了SR。接受TRSR的患者比未接受TRSR的患者有更多的合并症(CHA2DS2-VASc评分3.1比2.7,p = 0.012)。TRSR组的主要和次要结局均显著优于无TRSR组:无aa生存率(73% vs. 51%, p = 0.004)和无aa的AAD生存率(69% vs. 45%, p = 0.002)。无论CA时的心律是SR还是AF, TRSR组的主要结局都更好(分别为75%和72%)。结论:无论消融时的心律如何,CA后6个月内的TRSR与接受CA的LSPAF患者无心律失常生存率的提高相关。
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
CiteScore
5.20
自引率
14.80%
发文量
433
审稿时长
3-6 weeks
期刊介绍: Journal of Cardiovascular Electrophysiology (JCE) keeps its readership well informed of the latest developments in the study and management of arrhythmic disorders. Edited by Bradley P. Knight, M.D., and a distinguished international editorial board, JCE is the leading journal devoted to the study of the electrophysiology of the heart.
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