Efficacy of Low-Voltage-Area Ablation Is Enhanced in Patients With Advanced Left Atrial Enlargement: A Subanalysis of the SUPPRESS-AF Trial.

IF 9.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation. Arrhythmia and electrophysiology Pub Date : 2025-09-26 DOI:10.1161/CIRCEP.125.014210

Masaharu Masuda, Yasuhiro Matsuda, Hiroyuki Uematsu, Hirotaka Ooka, Satoshi Kudo, Mizuki Ochi, Toshiaki Mano, Akihiro Sunaga, Nobuaki Tanaka, Tetsuya Watanabe, Hitoshi Minamiguchi, Yasuyuki Egami, Takafumi Oka, Tomoko Minamisaka, Takashi Kanda, Masato Okada, Masato Kawasaki, Koji Tanaka, Nobuhiko Makino, Hirota Kida, Shungo Hikoso, Tomoharu Dohi, Koichi Inoue, Yohei Sotomi, Yasushi Sakata

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引用次数: 0

Abstract

Background: In the randomized controlled SUPPRESS-AF trial, the efficacy of low-voltage-area (LVA) ablation was highly dependent on the degree of atrial remodeling, while the efficacy was not statistically significant in total patients. This subanalysis of the SUPPRESS-AF trial aimed to compare the efficacy of LVA ablation in patient groups classified by left atrial diameter (LAD), which is a commonly used atrial remodeling index.

Methods: The SUPPRESS-AF trial included patients with persistent AF and left atrial LVAs, and compared rhythm outcomes between patients randomized to undergo pulmonary vein isolation (PVI) followed by left atrial LVA ablation group (n=170) or PVI-alone group (n=172). In this post hoc subanalysis, patients in each of the 2 randomly allocated groups were further divided into 2 groups using a median LAD of 44 mm.

Results: Atrial fibrillation or atrial tachycardia recurrence-free rates did not differ between patients with LAD>44 mm and ≤44 mm (60.1% versus 53.7%; P=0.261). Among patients with a LAD>44 mm, the LVA ablation group demonstrated a higher atrial fibrillation or atrial tachycardia-recurrence-free rate than the PVI-alone group (62.5% versus 43.4%; P=0.016). In contrast, no difference in atrial fibrillation or atrial tachycardia recurrence-free rate was found between the 2 groups of patients with a LAD≤44 mm (60.8% versus 59.6%; P=0.986).

Conclusions: The efficacy of LVA ablation in addition to PVI for the treatment of persistent AF was more pronounced in patients with a large left atrium.

Registration: URL: https://www.umin.ac.jp/ctr; Unique identifier: UMIN000035940.

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低压区域消融对晚期左房增大患者的疗效增强：抑制房颤试验的亚分析

背景：在随机对照SUPPRESS-AF试验中，低电压区（LVA）消融的疗效高度依赖于心房重构的程度，但总患者的疗效无统计学意义。这项对SUPPRESS-AF试验的亚分析旨在比较LVA消融在按左房直径（LAD）分类的患者组中的疗效，LAD是常用的心房重构指标。方法：SUPPRESS-AF试验纳入了持续性房颤和左房LVA患者，并比较随机分为肺静脉隔离（PVI）后左房LVA消融组（n=170）和单独PVI组（n=172）的患者的心律结局。在这项事后亚分析中，随机分配的两组患者分别被进一步分为中位LAD为44 mm的两组。结果：LAD为bbb44 mm和≤44 mm的患者心房颤动或房性心动过速无复发率无差异（60.1% vs 53.7%； P=0.261）。在LAD bbb44 mm的患者中，LVA消融组房颤或房性心动过速无复发率高于单独pvi组（62.5% vs 43.4%； P=0.016）。而LAD≤44 mm两组患者房颤、房速无复发率无差异（60.8% vs 59.6%， P=0.986）。结论：左心房大的患者，LVA消融加PVI消融治疗持续性房颤的疗效更为显著。注册：网址：https://www.umin.ac.jp/ctr；唯一标识符：UMIN000035940。

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

Circulation. Arrhythmia and electrophysiology 医学-心血管系统

CiteScore

13.70

自引率

4.80%

发文量

187

审稿时长

4-8 weeks

期刊介绍： Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.