{"title":"主观识别和消融心房冲动可改善持续性心房颤动的节律控制。CHAOS-AF 研究","authors":"","doi":"10.1016/j.recesp.2024.01.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>The optimal approach for persistent atrial fibrillation (AF) ablation remains unknown. In patients with persistent AF, we compared an ablation strategy based on pulmonary vein isolation (PVI) plus ablation of drivers (PVI<!--> <!-->+<!--> <!-->D), with a conventional PVI-only approach performed in a 1:1 propensity score-matched cohort.</p></div><div><h3>Methods</h3><p>Drivers were subjectively identified using conventional high-density mapping catheters (IntellaMap ORION, PentaRay NAV or Advisor HD Grid), without dedicated software, as fractionated continuous or quasicontinuous electrograms on 1 to 2 adjacent bipoles, which were ablated first; and as sites with spatiotemporal dispersion (the entire cycle length comprised within the mapping catheter) plus noncontinuous fractionation, which were only targeted in patients without fractionated continuous electrograms, or without AF conversion after ablation of fractionated continuous electrograms. Ablation included PVI plus focal or linear ablation targeting drivers.</p></div><div><h3>Results</h3><p>A total of 50 patients were included in each group (61<!--> <!-->±<!--> <!-->10 years, 25% women). Fractionated continuous electrograms were found and ablated in 21 patients from the PVI<!--> <!-->+<!--> <!-->D group (42%), leading to AF conversion in 7 patients. In the remaining 43 patients, 143 sites with spatiotemporal dispersion plus noncontinuous fractionation were targeted. Globally, AF conversion was achieved in 21 patients (42%). The PVI<!--> <!-->+<!--> <!-->D group showed lower atrial arrhythmia recurrences at 1 year of follow-up (30.6% vs 48%; <em>P</em> <!-->=<!--> <!-->.048) and at the last follow-up (46% vs 72%; <em>P</em> <!-->=<!--> <!-->.013), and less progression to permanent AF (10% vs 40%; <em>P</em> <!-->=<!--> <!-->.001).</p></div><div><h3>Conclusions</h3><p>Subjective identification and ablation of drivers, added to PVI, increased 1-year freedom from atrial arrhythmia and decreased long-term recurrences and progression to permanent AF.</p></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"77 9","pages":"Pages 723-733"},"PeriodicalIF":5.9000,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"La identificación subjetiva y ablación de impulsores auriculares mejora el control del ritmo en la fibrilación auricular persistente. Estudio CHAOS-AF\",\"authors\":\"\",\"doi\":\"10.1016/j.recesp.2024.01.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction and objectives</h3><p>The optimal approach for persistent atrial fibrillation (AF) ablation remains unknown. In patients with persistent AF, we compared an ablation strategy based on pulmonary vein isolation (PVI) plus ablation of drivers (PVI<!--> <!-->+<!--> <!-->D), with a conventional PVI-only approach performed in a 1:1 propensity score-matched cohort.</p></div><div><h3>Methods</h3><p>Drivers were subjectively identified using conventional high-density mapping catheters (IntellaMap ORION, PentaRay NAV or Advisor HD Grid), without dedicated software, as fractionated continuous or quasicontinuous electrograms on 1 to 2 adjacent bipoles, which were ablated first; and as sites with spatiotemporal dispersion (the entire cycle length comprised within the mapping catheter) plus noncontinuous fractionation, which were only targeted in patients without fractionated continuous electrograms, or without AF conversion after ablation of fractionated continuous electrograms. Ablation included PVI plus focal or linear ablation targeting drivers.</p></div><div><h3>Results</h3><p>A total of 50 patients were included in each group (61<!--> <!-->±<!--> <!-->10 years, 25% women). Fractionated continuous electrograms were found and ablated in 21 patients from the PVI<!--> <!-->+<!--> <!-->D group (42%), leading to AF conversion in 7 patients. In the remaining 43 patients, 143 sites with spatiotemporal dispersion plus noncontinuous fractionation were targeted. Globally, AF conversion was achieved in 21 patients (42%). The PVI<!--> <!-->+<!--> <!-->D group showed lower atrial arrhythmia recurrences at 1 year of follow-up (30.6% vs 48%; <em>P</em> <!-->=<!--> <!-->.048) and at the last follow-up (46% vs 72%; <em>P</em> <!-->=<!--> <!-->.013), and less progression to permanent AF (10% vs 40%; <em>P</em> <!-->=<!--> <!-->.001).</p></div><div><h3>Conclusions</h3><p>Subjective identification and ablation of drivers, added to PVI, increased 1-year freedom from atrial arrhythmia and decreased long-term recurrences and progression to permanent AF.</p></div>\",\"PeriodicalId\":21299,\"journal\":{\"name\":\"Revista espanola de cardiologia\",\"volume\":\"77 9\",\"pages\":\"Pages 723-733\"},\"PeriodicalIF\":5.9000,\"publicationDate\":\"2024-04-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Revista espanola de cardiologia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0300893224000356\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista espanola de cardiologia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0300893224000356","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
导言和目的持续性心房颤动(房颤)消融的最佳方法仍然未知。在持续性房颤患者中,我们比较了基于肺静脉隔离(PVI)和驱动因素消融(PVI + D)的消融策略,以及在 1:1 倾向评分匹配队列中仅采用传统 PVI 的方法。方法使用传统的高密度绘图导管(IntellaMap ORION、PentaRay NAV 或 Advisor HD Grid),在不使用专用软件的情况下,根据 1 到 2 个相邻双极上的连续或类连续电图分段主观地识别驱动因素,并首先对其进行消融;以及具有时空弥散(整个周期长度包含在映射导管内)和非连续分馏的部位,仅针对无分馏连续电图或分馏连续电图消融后无房颤转换的患者。消融包括 PVI 加局灶或线性消融靶向驱动器。结果 每组共纳入 50 名患者(61 ± 10 岁,25% 为女性)。PVI + D 组中有 21 名患者(42%)发现了分段连续电图并进行了消融,其中 7 名患者转为房颤。在其余 43 名患者中,143 个时空弥散加非连续分馏的部位成为目标。总体而言,21 名患者(42%)实现了房颤转复。PVI + D 组在随访 1 年(30.6% vs 48%;P = .048)和最后一次随访(46% vs 72%;P = .013)时的房性心律失常复发率较低,发展为永久性房颤的比例较低(10% vs 40%;P = .001)。
La identificación subjetiva y ablación de impulsores auriculares mejora el control del ritmo en la fibrilación auricular persistente. Estudio CHAOS-AF
Introduction and objectives
The optimal approach for persistent atrial fibrillation (AF) ablation remains unknown. In patients with persistent AF, we compared an ablation strategy based on pulmonary vein isolation (PVI) plus ablation of drivers (PVI + D), with a conventional PVI-only approach performed in a 1:1 propensity score-matched cohort.
Methods
Drivers were subjectively identified using conventional high-density mapping catheters (IntellaMap ORION, PentaRay NAV or Advisor HD Grid), without dedicated software, as fractionated continuous or quasicontinuous electrograms on 1 to 2 adjacent bipoles, which were ablated first; and as sites with spatiotemporal dispersion (the entire cycle length comprised within the mapping catheter) plus noncontinuous fractionation, which were only targeted in patients without fractionated continuous electrograms, or without AF conversion after ablation of fractionated continuous electrograms. Ablation included PVI plus focal or linear ablation targeting drivers.
Results
A total of 50 patients were included in each group (61 ± 10 years, 25% women). Fractionated continuous electrograms were found and ablated in 21 patients from the PVI + D group (42%), leading to AF conversion in 7 patients. In the remaining 43 patients, 143 sites with spatiotemporal dispersion plus noncontinuous fractionation were targeted. Globally, AF conversion was achieved in 21 patients (42%). The PVI + D group showed lower atrial arrhythmia recurrences at 1 year of follow-up (30.6% vs 48%; P = .048) and at the last follow-up (46% vs 72%; P = .013), and less progression to permanent AF (10% vs 40%; P = .001).
Conclusions
Subjective identification and ablation of drivers, added to PVI, increased 1-year freedom from atrial arrhythmia and decreased long-term recurrences and progression to permanent AF.
期刊介绍:
Revista Española de Cardiología, Revista bilingüe científica internacional, dedicada a las enfermedades cardiovasculares, es la publicación oficial de la Sociedad Española de Cardiología.