Individually tailored vs. standardized substrate modification during radiofrequency catheter ablation for atrial fibrillation: a randomized study
Individually tailored vs. standardized substrate modification during radiofrequency catheter ablation for atrial fibrillation: a randomized study
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DOI：
10.1093/europace/eux310
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发表时间：
2018-11-01
期刊：
影响因子：
6.1
通讯作者：
Hindricks, Gerhard
中科院分区：
文献类型：
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作者：
Kircher, Simon;Arya, Arash;Hindricks, Gerhard
目的 这项随机单中心研究旨在根据心房颤动 (AF) 的类型，比较肺静脉隔离 (PVI) 加电压引导消融与 PVI 加或不加线性消融的疗效和安全性。 方法和结果 总体而言，124 名未接受消融的阵发性或持续性 AF 患者随机接受 PVI 加（持续性 AF）或不加（阵发性 AF）附加线性消融（对照组）与 PVI 加上低压区域 (LVA) 消融相比，无论 AF 类型如何。在稳定窦性心律期间进行双极电压映射。 LVA 由 >= 3 个相邻映射点组成，与对照组患者相比，每个映射点在单次手术后（主要终点）的抗心律失常药物 (AAD) 后 30 秒内具有峰峰值幅度 [40/59 (68%) 与 25/59 (42%)，对数秩 P = 0.003]。在 33/59 例对照组患者 (56%) 和 41/59 LVA 消融组患者 (70%) 中发现使用或不使用 AAD 后无心律失常生存（调整后的对数秩 P = 0.10）。在第 12 个月的 7 天动态心电图监测期间，LVA 消融组中在 AAD 治疗或治疗后未出现心律失常复发的患者明显增多 [45/50 (90%) vs. 33/46 (72%)，P = 0.04]。在手术持续时间、透视时间和主要并发症方面没有观察到组间差异。 结论 在这项单中心研究中，与根据 AF 类型应用线性消融的传统方法相比，由电压映射引导的个性化定制基质修饰与显着更高的无心律失常生存率相关。
Aims This randomized single-centre study sought to compare the efficacy and safety of pulmonary vein isolation (PVI) plus voltage-guided ablation vs. PVI with or without linear ablation depending on the type of atrial fibrillation (AF).Methods and results Overall, 124 ablation-naive patients with paroxysmal or persistent AF were randomized to PVI with (persistent AF) or without (paroxysmal AF) additional linear ablation (control group) vs. PVI plus ablation of low-voltage areas (LVAs) irrespective of AF type. Bipolar voltage mapping was performed during stable sinus rhythm. An LVA consisted of >= 3 adjacent mapping points that each had a peak-to-peak amplitude 30 s off antiarrhythmic drugs (AADs) after a single procedure (primary endpoint) compared with control group patients [40/59 (68%) vs. 25/59 (42%), log-rank P = 0.003]. Arrhythmia-free survival on or off AADs was found in 33/59 control group patients (56%) and in 41/59 LVA ablation group patients (70%) (adjusted log-rank P = 0.10). During the 7 day Holter monitoring period at 12 months, significantly more patients in the LVA ablation group were free from arrhythmia recurrence on or off AADs [45/50 (90%) vs. 33/46 (72%), P = 0.04]. No between-group differences were observed regarding procedure duration, fluoroscopy time, and major complications.Conclusion In this single-centre study, individually tailored substrate modification guided by voltage mapping was associated with a significantly higher arrhythmia-free survival rate compared with a conventional approach applying linear ablation according to AF type.