PRECAF Randomized Controlled Trial.
PRECAF Randomized Controlled Trial.
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DOI：
10.1161/circep.120.008993
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Nazarian S
中科院分区：
文献类型：
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作者：
Kuo L;Frankel DS;Lin A;Arkles J;Hyman M;Santangeli P;Marchlinski FE;Nazarian S
我们之前已经证明，双肌冠状窦（CS）与左心房（LA）连接的存在，加上一侧肢体的速率依赖性单向阻滞，与心房颤动（AF）诱发相关。本研究旨在探讨首次 AF 消融时远端 CS 与 LA 连接的消融是否会减少随访期间心律失常的复发。在这项单中心、随机、对照试验中，连续 35 名在 2018 年 8 月至 2019 年 8 月期间接受首次消融的药物难治性 AF 患者被随机分配至 (1) 标准消融（肺静脉 [PV] 隔离和非 PV 触发消融），与 (2) 标准消融加消除远端 CS 与 LA 连接，目标是在远端 CS 起搏期间使用十极导管放置其近端电极口。局部 CS 心房电图的变化和 LA 激活序列到远端 CS 起搏期间 LA 间隔或屋顶的早期激活是 CS-LA 连接消除的终点。 30 名患者完成了 6 个月的研究随访（每组 15 名患者）。两组的人口统计学特征（包括年龄和房颤持续时间）相似。平均随访170±22天后，标准组房性心律失常复发7例，CS-LA连接消除组房性心律失常复发1例（46.7% vs 6.7%，HR 0.12，P=0.047）。在一项小型随机研究中，与标准 PV 隔离和非 PV 触发消融相比，消除远端 CS 至 LA 连接可减少接受首次 AF 消融手术的患者的房性心律失常复发。
We have previously shown that the presence of dual muscular coronary sinus (CS) to left atrial (LA) connections, coupled with rate-dependent unidirectional block in one limb, is associated with atrial fibrillation (AF) induction. This study sought to examine whether ablation of distal CS to LA connections at a first AF ablation reduces arrhythmia recurrence during follow-up. In this single center, randomized, controlled trial, 35 consecutive patients with drug refractory AF undergoing first time ablation between August, 2018 and August, 2019, were randomly assigned to (1) standard ablation (pulmonary vein [PV] isolation and non-PV trigger ablation), versus (2) standard ablation plus elimination of distal CS to LA connections targeting the earliest LA activation during distal CS pacing with a deca-polar catheter placed with its proximal electrode at the ostium. Change of the local CS atrial electrogram and LA activation sequence to early activation of the LA septum or roof during distal CS pacing were the endpoint for CS-LA connection elimination. Thirty patients completed 6 months study follow-up (15 patients in each group). Demographic characteristics including age and AF persistence were similar in both groups. After a mean follow-up of 170±22 days, there were 7 atrial arrhythmia recurrences in the standard group and 1 recurrence in the CS-LA connection elimination group (46.7% vs 6.7%, HR 0.12, P=0.047). Elimination of distal CS to LA connections reduced atrial arrhythmia recurrences compared to standard PV isolation and non-PV trigger ablation in patients undergoing a first AF ablation procedure in a small randomized study.