Department of Cardiology, Westmead Hospital, Sydney, Australia.
Circ Arrhythm Electrophysiol. 2012 Oct;5(5):968-77. doi: 10.1161/CIRCEP.111.970293. Epub 2012 Sep 12.
Electric isolation of the pulmonary veins and posterior left atrium with a single ring of radiofrequency lesions (single-ring isolation [SRI]) may result in fewer atrial fibrillation (AF) recurrences than wide antral pulmonary vein isolation (wide antral isolation [WAI]) by abolishing extravenous AF triggers. The effect of mitral isthmus line (MIL) ablation on outcomes after SRI has not previously been assessed.
We randomly assigned 220 consecutive patients (58 ± 10 years old; 82% men) with highly symptomatic AF (61% paroxysmal, 39% persistent/longstanding persistent) to undergo either SRI or WAI. Half of each cohort was also randomly allocated to have left lateral MIL ablation (2 ×2 factorial study design). Patients were followed clinically and with 7-day Holter studies for arrhythmia recurrences. The primary end points were recurrence of AF and organized atrial tachyarrhythmias. AF-free survival at 2 years was better after SRI (74% [95% CI, 65%-82%]) than WAI (61% [51%-70%]; P=0.031). Organized atrial tachyarrhythmia-free survival was similar after SRI and WAI (67% [57%-75%] ersus 64% [54%-72%], respectively, at 2 years; P=0.988). MIL ablation resulted in better 2-year organized atrial tachyarrhythmia-free survival (71% [62%-79%] versus 60% [50%-69%]; P=0.07), which approached statistical significance. Survival free of any atrial arrhythmia after one procedure was not significantly affected by isolation technique or MIL ablation. Conclusions- SRI resulted in fewer AF recurrences compared with WAI on long-term follow-up but did not reduce the recurrence of all atrial arrhythmias. MIL ablation may reduce organized atrial tachyarrhythmia recurrences. Clinical Trial Registration- http://www.anzctr.org.au; ACTRN12606000467538.
与广泛的肺静脉前庭隔离（广泛肺静脉隔离[WAI]）相比，通过消融一条环肺静脉和左心房后侧壁的射频消融线（单环隔离[SRI]）可能会减少心房颤动（AF）的复发，因为它消除了额外的静脉触发因素。然而，此前尚未评估二尖瓣峡部线（MIL）消融对 SRI 后结果的影响。
我们连续入选了 220 例有症状的 AF 患者（58±10 岁；82%为男性），这些患者的 AF 为高度症状性（61%为阵发性，39%为持续性/长期持续性），他们被随机分为 SRI 或 WAI 组。每个队列的一半患者也被随机分为接受左侧外侧 MIL 消融（2×2 析因研究设计）。通过临床和 7 天 Holter 研究来随访心律失常的复发情况。主要终点是 AF 和有组织的房性心动过速的复发。2 年时，SRI 的 AF 无复发生存率（74%[95%CI，65%-82%]）优于 WAI（61%[51%-70%]；P=0.031）。SRI 和 WAI 的有组织的房性心动过速无复发生存率相似（2 年时分别为 67%[57%-75%]和 64%[54%-72%]；P=0.988）。MIL 消融使 2 年时的有组织的房性心动过速无复发生存率更好（71%[62%-79%]与 60%[50%-69%]；P=0.07），但未达到统计学意义。单次手术治疗后，无任何房性心律失常的生存率不受隔离技术或 MIL 消融的影响。
在长期随访中，与 WAI 相比，SRI 可减少 AF 的复发，但不能减少所有房性心律失常的复发。MIL 消融可能减少有组织的房性心动过速的复发。
