Additional Low-Voltage-Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO Trial.
Additional Low-Voltage-Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO Trial.
复制标题
DOI：
10.1161/jaha.120.015927
复制
发表时间：
2020-07-07
影响因子：
5.4
通讯作者：
Mano T
中科院分区：
文献类型：
--
作者：
Masuda M;Asai M;Iida O;Okamoto S;Ishihara T;Nanto K;Kanda T;Tsujimura T;Matsuda Y;Okuno S;Hata Y;Mano T
低压区（LVA）消融的有效性尚未得到很好的确定。本研究旨在研究LVA消融加肺静脉电隔离对阵发性房颤（AF）患者心律结局的有效性。火山（阵发性房颤患者肺静脉隔离后靶向低电压区域的导管消融）试验包括接受初始房颤消融的阵发性房颤患者。在398例肺静脉电隔离后获得左心房电压图的患者中，336例（85%）无LVA（A组）。其余62例（15%）LVA患者以1：1的比例随机分配接受LVA消融（B组，n=30）或不接受LVA消融（C组，n=32）。主要终点为1年无房颤复发生存率。未发生与LVA消融相关的不良事件。B组的手术时间（124±40 vs 95±33分钟，P=0.003）和透视时间（29±11 vs 24±8分钟，P=0.034）均长于C组。左心室肥大患者的无房颤复发生存率（88%）低于无左心室肥大患者（B，57%，P<0.0001; C，53%，P<0.0001）。然而，除肺静脉隔离外，LVA消融并未影响AF无复发生存率（B组vs C组，P=0.67）。LVA的存在是阵发性房颤患者肺静脉电隔离术后房颤复发的强预测因素。然而，LVA消融对1年心律结局无有利影响。URL：https：//www.umin.ac.jp/ctr;唯一标识符：UMIN 000023403。
The efficacy of low‐voltage‐area (LVA) ablation has not been well determined. This study aimed to investigate the efficacy of LVA ablation in addition to pulmonary vein isolation on rhythm outcomes in patients with paroxysmal atrial fibrillation (AF). VOLCANO (Catheter Ablation Targeting Low‐Voltage Areas After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Patients) trial included paroxysmal AF patients undergoing initial AF ablation. Of 398 patients in whom a left atrial voltage map was obtained after pulmonary vein isolation, 336 (85%) had no LVA (group A). The remaining 62 (15%) patients with LVAs were randomly allocated to undergo LVA ablation (group B, n=30) or not (group C, n=32) in a 1:1 fashion. Primary end point was 1‐year AF‐recurrence‐free survival rate. No adverse events related to LVA ablation occurred. Procedural (124±40 versus 95±33 minutes, P=0.003) and fluoroscopic times (29±11 versus 24±8 minutes, P=0.034) were longer in group B than group C. Patients with LVAs demonstrated lower AF‐recurrence‐free survival rates (88%) than those without LVA (B, 57%, P<0.0001; C, 53%, P<0.0001). However, LVA ablation in addition to pulmonary vein isolation did not impact AF‐recurrence‐free survival rate (group B versus C, P=0.67). The presence of LVA was a strong predictor of AF recurrence after pulmonary vein isolation in patients with paroxysmal AF. However, LVA ablation had no beneficial impact on 1‐year rhythm outcomes. URL: https://www.umin.ac.jp/ctr; Unique identifier: UMIN000023403.