持续性心房颤动患者重做手术中初始广泛消融对左心房间隙的影响及后续结果。

IF 9.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation. Arrhythmia and electrophysiology Pub Date : 2025-06-01 Epub Date: 2025-06-02 DOI:10.1161/CIRCEP.124.013612

Masato Okada, Koichi Inoue, Nobuaki Tanaka, Masaharu Masuda, Tetsuya Watanabe, Nobuhiko Makino, Yasuyuki Egami, Takafumi Oka, Hitoshi Minamiguchi, Miwa Miyoshi, Takashi Kanda, Yasuhiro Matsuda, Masato Kawasaki, Koji Tanaka, Yuko Hirao, Shungo Hikoso, Akihiro Sunaga, Tomoharu Dohi, Daisaku Nakatani, Katsuki Okada, Yohei Sotomi, Yasushi Sakata

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引用次数: 0

摘要

背景：除肺静脉（PV）隔离外，广泛线性消融策略在持续性房颤（AF）消融中的有效性仍存在争议。先前消融病灶的间隙可引起心律失常，并可能降低广泛消融的有效性。本研究在EARNEST-PVI试验中评估了传导间隙、间隙相关的再入以及AF消融后的复发发生率(单独肺静脉隔离治疗持续性心房颤动患者的疗效；注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT03514693)。方法：该试验是一项评估持续性房颤指标消融策略的随机对照研究。在512名试验参与者中，115名接受房颤消融（肺静脉隔离[PVI]-单独消融[n=69]和PVI +线性消融[n=46]）的患者被纳入本研究。比较pvi单独重做组和pvi加线性消融重做组的左房传导间隙、重做过程中左房心动过速的发生以及随后的复发情况。结果：在pvi单独重做组中，38例（57%）患者观察到电PV间隙。在pvi +重做组中，19例（41%）有PV间隙，10例（22%）有左心房线状间隙，11例（24%）两者均有间隙。重做期间，15例患者出现19例左房性心动过速。pvi +组房性心动过速发生率高于单独pvi组(23.9% vs 5.8%；P = 0.005)。左房性心动过速的发生与线状病变间隙相关，而单独的左房性心动过速与重做后的复发相关(风险比，0.54 [95% CI, 0.31-0.95]；P = 0.033)。结论：在EARNEST-PVI试验的再次房颤消融中，在指数过程中进行广泛线性消融的患者左房传导间隙更频繁。虽然重做时所有间隙都可能引起心律失常，但单PV间隙与重做房颤消融后的复发有关。注册：网址：https://www.umin.ac.jp/ctr/index-j.htm；唯一标识符：UMIN000019449。

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Impact of Initial Extensive Ablation on Left Atrial Gaps During Redo Procedures and Subsequent Outcomes in Persistent Atrial Fibrillation.

Background: The efficacy of extensive linear ablation strategies, in addition to pulmonary vein (PV) isolation, remains controversial in persistent atrial fibrillation (AF) ablation. Gaps in previously ablated lesions can induce arrhythmias and potentially decrease the effectiveness of extensive ablation. This study evaluated the incidence of conduction gaps, gap-related reentry, and subsequent recurrence following redo AF ablation in the EARNEST-PVI trial (Efficacy of Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation; REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03514693).

Methods: The EARNEST-PVI trial is a randomized controlled study evaluating index ablation strategies for persistent AF. Of the 512 trial participants, 115 who underwent redo AF ablation (pulmonary vein isolation [PVI]-alone redo [n=69] and PVI-plus linear redo [n=46]) were included in the present study. Left atrial conduction gaps, the occurrence of left atrial tachycardias during redo procedures, and subsequent recurrences were compared between the PVI-alone redo group and the PVI-plus linear ablation redo group.

Results: In the PVI-alone redo group, electrical PV gaps were observed in 38 (57%) patients. In the PVI-plus redo group, 19 (41%) had PV gaps, 10 (22%) had gaps in left atrial linear lines, and 11 (24%) had gaps in both. During the redo session, 19 left atrial tachycardias were observed or induced in 15 patients. Atrial tachycardias were more frequently observed in the PVI-plus group than in the PVI-alone group (23.9% versus 5.8%; P=0.005). The occurrence of left atrial tachycardias was associated with gaps in linear lesions, whereas PV gaps alone were associated with subsequent recurrence after redo (hazard ratio, 0.54 [95% CI, 0.31-0.95]; P=0.033).

Conclusions: In the redo AF ablation of the EARNEST-PVI trial, left atrial conduction gaps were more frequent in patients who underwent extensive linear ablation during the index procedure. While all gaps during redo were potentially arrhythmogenic, PV gaps alone were associated with recurrence after redo AF ablation.

Registration: URL: https://www.umin.ac.jp/ctr/index-j.htm; Unique identifier: UMIN000019449.

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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.