Marco Bergonti, Philipp Krisai, Ciro Ascione, Thomas Pambrun, Domenico G Della Rocca, Paolo Compagnucci, Tardu Özkartal, Lorenzo Marcon, Teba Gonzalez Ferrero, Luigi Pannone, Michael Kühne, Matteo Anselmino, Michela Casella, Teodor Serban, Claudio Tondo, Moises Rodríguez-Mañero, Maria Luce Caputo, Patrick Badertscher, Nicolas Derval, Carlo de Asmundis, Gian Battista Chierchia, Hein Heidbuchel, Pierre Jaïs, Angelo Auricchio, Andrea Sarkozy, Giulio Conte
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Whether PVI+L/LVA provides additional benefits in this population has never been systematically investigated.</p><p><strong>Objectives: </strong>This study sought to analyze the temporal trends and comparative outcomes of PVI+L/LVA vs PVI alone.</p><p><strong>Methods: </strong>Patients with HFrEF undergoing atrial fibrillation ablation were retrospectively enrolled. The 2 coprimary endpoints were ventricular function recovery and atrial fibrillation recurrence-free survival at 1 year. The performance of PVI and PVI+L/LVA was compared in the overall population and in 2 matched groups. A sensitivity analysis for measured confounders was performed.</p><p><strong>Results: </strong>A total of 955 HFrEF patients (62.1 years, 24.4% female) from 9 international centers were included (PVI only 51.6% vs PVI+L/LVA 48.4%). At 12 months after the procedure, 62.3% of the patients remained free from arrhythmia recurrences and 65.4% experienced ventricular function recovery. Comparing PVI to PVI+L/LVA, no significant difference in the 2 coprimary endpoints was observed, neither in the overall nor in the matched cohorts. The use of PVI+L/LVA increased from 27% in 2013 to 68% in 2022. Patients undergoing PVI+L/LVA experienced more complications (3.8 vs 1.2%; P = 0.018).</p><p><strong>Conclusions: </strong>Catheter ablation is associated with significant improvements in systolic function, irrespective of the ablation strategy used. The use of PVI+L/LVA in HFrEF patients is progressively expanding over time. Although the benefits of this practice remain unproven, it is associated with an increased risk of overall and nonvascular complications. These results warrant caution regarding the growing use of PVI+ in HFrEF patients.</p>","PeriodicalId":14573,"journal":{"name":"JACC. 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引用次数: 0
摘要
背景：导管消融房颤已被证明对心力衰竭和射血分数降低（HFrEF）患者有益。在肺静脉隔离（PVI）的基础上，通常采用经验线/后盒/低压消融（PVI+L/LVA）等附加消融策略。PVI+L/LVA是否在这一人群中提供额外的益处从未系统地研究过。目的：本研究旨在分析PVI+L/LVA与单独PVI的时间趋势和比较结果。方法：回顾性分析心房颤动消融的HFrEF患者。2个主要终点是1年心室功能恢复和房颤无复发生存率。比较总体和2个配对组的PVI和PVI+L/LVA的表现。对测量的混杂因素进行敏感性分析。结果：共纳入来自9个国际中心的955例HFrEF患者（62.1岁，24.4%为女性）（PVI仅51.6% vs PVI+L/LVA 48.4%）。术后12个月，62.3%的患者无心律失常复发，65.4%的患者心室功能恢复。将PVI与PVI+L/LVA进行比较，无论是在总体上还是在匹配的队列中，都没有观察到2个主要终点的显著差异。PVI+L/LVA的使用率从2013年的27%上升到2022年的68%。接受PVI+L/LVA的患者出现了更多的并发症(3.8% vs 1.2%；p = 0.018)。结论：无论采用何种消融策略，导管消融与收缩功能的显著改善相关。随着时间的推移，PVI+L/LVA在HFrEF患者中的应用逐渐扩大。尽管这种做法的益处尚未得到证实，但它与整体和非血管并发症的风险增加有关。这些结果表明，在HFrEF患者中越来越多地使用PVI+需要谨慎。
Different Approaches to Atrial Fibrillation Ablation in Heart Failure Patients: Temporal Trends and Clinical Outcomes.
Background: Catheter ablation of atrial fibrillation has been proven beneficial in patients with heart failure and reduced ejection fraction (HFrEF). On top of pulmonary vein isolation (PVI), additional ablation strategies such as empirical lines/posterior box/low voltage ablation (PVI+L/LVA) are often used. Whether PVI+L/LVA provides additional benefits in this population has never been systematically investigated.
Objectives: This study sought to analyze the temporal trends and comparative outcomes of PVI+L/LVA vs PVI alone.
Methods: Patients with HFrEF undergoing atrial fibrillation ablation were retrospectively enrolled. The 2 coprimary endpoints were ventricular function recovery and atrial fibrillation recurrence-free survival at 1 year. The performance of PVI and PVI+L/LVA was compared in the overall population and in 2 matched groups. A sensitivity analysis for measured confounders was performed.
Results: A total of 955 HFrEF patients (62.1 years, 24.4% female) from 9 international centers were included (PVI only 51.6% vs PVI+L/LVA 48.4%). At 12 months after the procedure, 62.3% of the patients remained free from arrhythmia recurrences and 65.4% experienced ventricular function recovery. Comparing PVI to PVI+L/LVA, no significant difference in the 2 coprimary endpoints was observed, neither in the overall nor in the matched cohorts. The use of PVI+L/LVA increased from 27% in 2013 to 68% in 2022. Patients undergoing PVI+L/LVA experienced more complications (3.8 vs 1.2%; P = 0.018).
Conclusions: Catheter ablation is associated with significant improvements in systolic function, irrespective of the ablation strategy used. The use of PVI+L/LVA in HFrEF patients is progressively expanding over time. Although the benefits of this practice remain unproven, it is associated with an increased risk of overall and nonvascular complications. These results warrant caution regarding the growing use of PVI+ in HFrEF patients.
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.
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