A Randomized Assessment of the Incremental Role of Ablation of Complex Fractionated Atrial Electrograms After Antral Pulmonary Vein Isolation for Long-Lasting Persistent Atrial Fibrillation
A Randomized Assessment of the Incremental Role of Ablation of Complex Fractionated Atrial Electrograms After Antral Pulmonary Vein Isolation for Long-Lasting Persistent Atrial Fibrillation
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DOI：
10.1016/j.jacc.2008.10.054
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发表时间：
2009-03-03
影响因子：
24
通讯作者：
Morady, Fred
中科院分区：
文献类型：
--
作者：
Oral, Hakan;Chugh, Aman;Morady, Fred
目的本研究旨在确定心房肺静脉隔离（APVI）后复杂分割心房电图（CFAEs）消融是否能进一步改善持久持续性心房颤动（AF）患者APVI的临床结果。背景：有报道称CFAEs消融可消除持续性房颤。然而，残留的肺静脉致心律失常性是房颤复发的常见机制。方法：在这项随机研究中，119例持续性房颤患者（平均年龄60 +/- 9岁）连续接受APVI治疗，并使用尖端射频消融导管。119例患者中有19例（A组，16%）经肺静脉隔离后房颤终止。剩下的100名仍然患有房颤的患者被随机分配到不进行进一步消融并进行心律转复（B组，n = 50）或左心房或冠状窦CFAEs消融最多2小时的手术时间（C组，n = 50）。结果C组50例患者中有9例（18%）在CFAEs消融过程中房颤终止。在单次消融后10 +/- 3个月，B组50例患者中有18例（36%）和C组50例患者中有17例（34%）在未使用抗心律失常药物的情况下处于窦性心律（p = 0.84）。A组19例患者中15例（79%）处于窦性心律。100例随机患者中有34例接受了重复消融手术（房颤30例，心房扑动4例）。最终手术后9 +/- 4个月，B组50例中有34例（68%），C组50例中有30例（60%）未使用抗心律失常药物（p = 0.40）。结论：APVI术后2小时的CFAEs额外消融似乎并不能改善长期持续性房颤患者的临床结果（J Am Coll Cardiol 2009; 53: 782-9） (C) 2009
Objectives This study sought to determine whether ablation of complex fractionated atrial electrograms (CFAEs) after antral pulmonary vein isolation (APVI) further improves the clinical outcome of APVI in patients with long-lasting persistent atrial fibrillation (AF).Background Ablation of CFAEs has been reported to eliminate persistent AF. However, residual pulmonary vein arrhythmogenicity is a common mechanism of recurrence.Methods In this randomized study, 119 consecutive patients (mean age 60 +/- 9 years) with long-lasting persistent AF underwent APVI with an irrigated-tip radiofrequency ablation catheter. Antral pulmonary vein isolation resulted in termination of AF in 19 of 119 patients (Group A, 16%). The remaining 100 patients who still were in AF were randomized to no further ablation and underwent cardioversion (Group B, n = 50) or to ablation of CFAEs in the left atrium or coronary sinus for up to 2 additional hours of procedure duration (Group C, n = 50).Results Atrial fibrillation terminated during ablation of CFAEs in 9 of 50 patients (18%) in Group C. At 10 +/- 3 months after a single ablation procedure, 18 of 50 (36%) in Group B and 17 of 50 (34%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.84). In Group A, 15 of 19 patients (79%) were in sinus rhythm. A repeat ablation procedure was performed in 34 of 100 randomized patients (for AF in 30 and atrial flutter in 4). At 9 +/- 4 months after the final procedure, 34 of 50 (68%) in Group B and 30 of 50 (60%) in Group C were in sinus rhythm without antiarrhythmic drugs (p = 0.40).Conclusions Up to 2 h of additional ablation of CFAEs after APVI does not appear to improve clinical outcomes in patients with long-lasting persistent AF. (J Am Coll Cardiol 2009; 53: 782-9) (C) 2009 by the American College of Cardiology Foundation