Prophylactic pulmonary vein isolation during isthmus ablation for atrial flutter: Three-year outcomes of the PREVENT AF I study
Prophylactic pulmonary vein isolation during isthmus ablation for atrial flutter: Three-year outcomes of the PREVENT AF I study
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DOI：
10.1111/jce.13485
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发表时间：
2018-06-01
影响因子：
2.7
通讯作者：
Steinberg, Jonathan S.
中科院分区：
文献类型：
--
作者：
Romanov, Alexander;Pokushalov, Evgeny;Steinberg, Jonathan S.
简介：PREVENT AF I 研究表明，根据连续植入式心脏监护仪 (ICM) 的评估，单纯典型心房扑动 (AFL) 患者的预防性肺静脉隔离 (PVI) 可在 1 年随访期间大幅减少新发心房颤动 (AF)。本研究的目的是评估 3 年结果。方法和结果：50 名有 AFL 记录的患者被随机分配接受单独腔三尖瓣峡部 (CTI) 消融 (n = 25) 或 CTI 联合 PVI (n = 25)。该研究的主要终点是 ICM 每月负担超过 0.5% 的任何房性快速心律失常的发生情况。 3 年结束时，CTI 加 PVI 组中无任何房性快速心律失常的比例为 48%（95% 置信区间 [CI]：32-72%），而仅 CTI 组的比例为 20%（95% CI：9-44%）（P = 0.01）。无需重做手术的比例也较高：分别为 92% (95% CI: 82-100%) 和 68% (95% CI: 52-89%) (P = 0.027)。 3 年 AF 负担有利于联合消融组：6.2% 对比 16.8%（P = 0.03）。在仅 CTI 组中，有 12 名患者 (48%) 住院，而 PVI + CTI 组中有 4 名患者 (16%) 住院 (P = 0.03)。仅使用 CTI 组中的 2 名患者出现中风，而 PVI + CTI 组中没有出现严重不良事件。 结论：对于仅患有典型 AFL 的患者，预防性 PVI 显着减少了新发 AF 和长期随访期间的负担（经 ICM 评估），从而减少了住院治疗和需要进行 AF 重复消融的情况。
Introduction: The PREVENT AF I study demonstrated that prophylactic pulmonary vein isolation (PVI) in patients with pure typical atrial flutter (AFL) resulted in substantial reduction of new-onset atrial fibrillation (AF) during 1-year follow-up as assessed by continuous implantable cardiac monitor (ICM). The objective of this study was to assess 3-year outcomes.Methods and results: Fifty patients with documented AFL were randomized to either cavotri-cuspid isthmus (CTI) ablation alone (n = 25) or CTI with concomitant PVI (n = 25). The primary endpoint of the study was the occurrence of any atrial tachyarrhythmia with the monthly burden exceeding 0.5% on the ICM. At the end of 3 years, freedom from any atrial tachyarrhythmia was 48% (95% confidence interval [CI]: 32-72%) in the CTI plus PVI group as compared to 20% (95% CI: 9-44%) in the CTI-only group (P = 0.01). Freedom from redo procedures was also higher: 92% (95% CI: 82-100%) versus 68% (95% CI: 52-89%), respectively (P = 0.027). The 3-year AF burden favored the combined ablation group: 6.2% versus 16.8% (P = 0.03). In the CTI-only group, 12 (48%) patients were hospitalized compared to 4 (16%) in the PVI + CTI group (P = 0.03). Two patients in the CTI-only group developed stroke with no serious adverse events in the PVI + CTI group.Conclusion: Prophylactic PVI in patients with only typical AFL resulted in a significant reduction of new-onset AF and burden during long-term follow-up as assessed by ICM, with consequent reduction in hospitalizations and need to perform repeat ablation for AF.