房颤重复消融策略的真实世界结果：来自日本导管消融登记的见解

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia Pub Date : 2025-09-22 DOI:10.1002/joa3.70200

Yasuhiro Matsuda, Masaharu Masuda, Koshiro Kanaoka, Toshiaki Mano, Koichi Inoue, Seigo Yamashita, Yu-Ki Iwasaki, Kohki Nakamura, Koichi Nagashima, Koji Miyamoto, Kazuhiro Satomi, Seiji Takatsuki, Kengo Kusano, Teiichi Yamane, Wataru Shimizu

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引用次数: 0

摘要

背景：由于心律失常复发性心房颤动（AF）患者经常需要重复消融。虽然肺静脉隔离（PVI）是重复消融中唯一推荐的消融技术，但临床实践中通常使用各种其他策略。本研究的目的是评估日本重复消融策略的实施、疗效和安全性。方法本研究采用日本导管消融注册（J-AB Registry）进行。2017年8月至2020年12月期间，共有26684例房颤患者接受了第二次消融手术，并对患者特征、手术特征和并发症进行了分析。此外，还研究了1508例消融手术患者在12个月随访期间的房颤复发率。结果在第二次消融术中，20938例（78%）患者行重复肺静脉隔离术（re-PVI）， 14552例（55%）患者行左房附加消融术。1086例（38%）患者同时行re-PVI和左房附加消融。随着第二次消融过程中左房附加消融次数的增加，总并发症发生率也显著增加（阵发性房颤，p < 0.001；持续性房颤，p < 0.001）。在随访期间，阵发性房颤的复发率为87.6%，持续性房颤的复发率为80.6%。结论在日本进行的第二次消融术中，78%的患者需要再pvi， 38%的患者需要再pvi和左房附加消融术。随着左房额外消融次数的增加，总并发症发生率也增加。J-AB注册已在UMIN临床试验注册中心（UMIN 000028288）和ClinicalTrials.gov （NCT03729232）注册。

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Real-World Outcomes of Repeat Ablation Strategies for Atrial Fibrillation: Insights From the Japanese Catheter Ablation Registry

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Real-World Outcomes of Repeat Ablation Strategies for Atrial Fibrillation: Insights From the Japanese Catheter Ablation Registry

Background

Repeat ablation is often required in patients with atrial fibrillation (AF) due to recurrent arrhythmias. Although pulmonary vein isolation (PVI) is the only recommended ablation technique for repeat ablation, various additional strategies are commonly used in clinical practice. The purpose of this study was to evaluate the implementation, efficacy, and safety of repeat ablation strategies in Japan.

Methods

This study was conducted by using the Japanese Catheter Ablation Registry (J-AB registry). A total of 26 684 patients who underwent a second ablation procedure for AF between August 2017 and December 2020 were included and analyzed for patient characteristics, procedural characteristics, and complications. Additionally, the AF recurrence rate over a 12-month follow-up period was also investigated in 1508 s ablation procedures.

Results

In the second ablation procedure, repeat-pulmonary vein isolation (re-PVI) was performed for 20 938 (78%) patients and 14 552 (55%) patients underwent left atrial additional ablation. Both of re-PVI and left atrial additional ablation were performed for 10 086 (38%) patients. As the number of left atrial additional ablations in the second ablation procedure increased, the overall complication rate also significantly increased (paroxysmal AF, p < 0.001; persistent AF, p < 0.001). The rate of freedom from AF recurrence during the follow-up period was 87.6% for paroxysmal AF and 80.6% for persistent AF.

Conclusions

In the second ablation procedure performed in Japan, re-PVI was required in 78% of patients, and both of re-PVI and left atrial additional ablation were performed for 38% of patients. As the number of left atrial additional ablations increased, the overall complication rate also increased.