新诊断心房颤动导管消融后心律失常复发及节律控制策略（ARRC-AF研究）。

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-04-01 DOI:10.1016/j.jacep.2024.11.020

Sanjeev Saksena MD , Jennifer Ken-Opurum PhD , David S. McKindley PharmD , Ron Preblick PharmD, MPH , Jason Rashkin MD , Omar M. Aldaas MD , Sesha Sai Srinivas Sistla MBA , Jonathan C. Hsu MD, MAS

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引用次数: 0

摘要

背景：房颤（AF）的心律控制可以通过导管消融来实现，但心律失常复发可能需要进一步干预。目的：本研究的目的是表征指数消融后的心律控制策略。方法：在Optum确定的市场清晰度数据中，共有2,429,863例因新诊断的房间隔接受指数消融的患者（2007-2021年）被随访至受试者退组、死亡或研究结束。重复的替代品;心房颤动、心房扑动或其他指数消融后的心动过速；以及消融术后抗心律失常药物（AAD）的使用情况。结果：共有23,323例患者接受了指数消融（中位随访时间1,165天）；3862例（16.6%）接受≥2次消融(2次消融，14.2%；消融3例，2.0%；消融≥4例，0.4%)。在重复消融的患者中，个体房颤或心房扑动事件（n = 7907）平均每名患者2.0次，而其他编码心律失常（n = 2298）平均每名患者0.6次。指数消融后AAD的使用很常见（46.9%），在≥1次重复消融的患者中，AAD的使用从62.8%到92.3%不等。反复消融与房颤表型相关(长期持续性vs阵发性；发病率比[IRR]: 2.26；95% CI: 1.27-3.68)， AAD使用(vs无使用；IRR: 1.42;95% CI: 1.30-1.56)，阻塞性睡眠呼吸暂停(vs无阻塞性睡眠呼吸暂停；IRR: 1.26;95% CI: 1.20-1.33)，瓣膜性心脏病(vs无瓣膜性心脏病；IRR: 1.12;95% CI: 1.07-1.18)，冠状动脉疾病(vs无冠状动脉疾病；IRR: 1.13;95% CI: 1.07-1.19)，体重指数30 - 35 kg/m2 (vs 2；IRR: 1.10;95% ci: 1.02-1.20)。结论：在这项研究中，在指数消融后，额外的心律控制策略经常继续。每6例患者中就有1例接受了重复消融治疗，大多数患者同时接受了AAD治疗。这些数据表明，导管消融和AADs的联合策略目前在实践中用于心律控制。

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Arrhythmia Recurrence and Rhythm Control Strategies After Catheter Ablation of Newly Diagnosed Atrial Fibrillation (ARRC-AF Study)

Background

Rhythm control in atrial fibrillation (AF) can be achieved with catheter ablation, but arrhythmia recurrences can require further interventions.

Objectives

The aim of this study was to characterize rhythm-control strategies after index ablation.

Methods

A total of 2,429,863 patients in Optum’s deidentified Market Clarity Data who underwent index ablation for newly diagnosed AF (2007-2021) were followed until disenrollment, death, or study end. Repeat ablations; AF, atrial flutter, or other tachycardias following index ablation; and antiarrhythmic drug (AAD) practices after ablation were examined.

Results

In total, 23,323 patients underwent index ablation (median follow-up duration 1,165 days); 3,862 (16.6%) underwent ≥2 ablations (2 ablations, 14.2%; 3 ablations, 2.0%; ≥4 ablations, 0.4%). In patients with repeat ablations, incident individual AF or atrial flutter patient events (n = 7,907) averaged 2.0 per patient, while other coded arrhythmias (n = 2,298) averaged 0.6 per patient. AAD use after index ablation was common (46.9% overall), ranging from 62.8% to 92.3% among patients with ≥1 repeat ablation. Repeat ablation was associated with AF phenotype (long-standing persistent vs paroxysmal; incidence rate ratio [IRR]: 2.26; 95% CI: 1.27-3.68), AAD use (vs no use; IRR: 1.42; 95% CI: 1.30-1.56), obstructive sleep apnea (vs no obstructive sleep apnea; IRR: 1.26; 95% CI: 1.20-1.33), valvular heart disease (vs no valvular heart disease; IRR: 1.12; 95% CI: 1.07-1.18), coronary artery disease (vs no coronary artery disease; IRR: 1.13; 95% CI: 1.07-1.19), and body mass index 30 to 35 kg/m² (vs <30 kg/m²; IRR: 1.10; 95% CI: 1.02-1.20).

Conclusions

In this study, additional rhythm-control strategies were frequently continued after index ablation. One in 6 patients underwent repeat ablation, with the majority receiving concomitant AAD therapy. These data indicate that a combined strategy of catheter ablation and AADs is currently used in practice for rhythm control.

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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.