Steinberg Jonathan S, Romanov Alexander, Musat Dan, Preminger Mark, Bayramova Sevda, Artyomenko Sergey, Shabanov Vitaliy, Losik Denis, Karaskov Alexander, Shaw Richard E, Pokushalov Evgeny
The Arrhythmia Institute, Valley Health System, New York, New York; University of Rochester School of Medicine and Dentistry, Rochester, New York.
State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Heart Rhythm. 2014 Sep;11(9):1567-72. doi: 10.1016/j.hrthm.2014.05.011. Epub 2014 May 12.
Although catheter ablation of isthmus-dependent atrial flutter (AFL) is successful at eliminating the target arrhythmia, many patients subsequently experience new-onset atrial fibrillation (AF).
The aim of this study was to determine whether AF can be prevented by prophylactic pulmonary vein ablation in patients with AFL.
A prospective, single-blind, randomized clinical trial in patients whose sole arrhythmia was AFL without AF was conducted. Patients were randomized to cavotricuspid isthmus ablation alone or with concomitant pulmonary vein isolation. All patients received an implantable cardiac monitor.
Fifty patients completed the trial, and patients were well matched. Isthmus ablation was successful in all patients; pulmonary vein isolation was successful in 25 (100%) randomized patients. Procedure (P < .0001) and fluoroscopy (P < .0001) times were longer in the combined ablation group. More patients in the isthmus ablation-only group experienced new-onset AF during follow-up (52% vs. 12%; P = .003). The 1-year AF burden also favored the combined ablation group compared with the isthmus ablation-only group (8.3% vs. 4.0%; P = .034). In the isthmus ablation-only group, 8 (32%) patients subsequently underwent another ablation for AF. The performance of pulmonary vein isolation and male sex were independent predictors of freedom from AF.
In the PREVENT-AF Study I randomized clinical trial of patients in whom only typical AFL had been observed clinically, the addition of pulmonary vein isolation to cavotricuspid isthmus ablation resulted in a marked reduction of new-onset AF during clinical follow-up as assessed with a continuous implantable cardiac monitor.
尽管峡部依赖性房扑（AFL）的导管消融术在消除目标心律失常方面很成功，但许多患者随后会出现新发房颤（AF）。
本研究旨在确定AFL患者是否可通过预防性肺静脉消融术预防房颤。
对仅患有AFL而无房颤的患者进行了一项前瞻性、单盲、随机临床试验。患者被随机分为单独进行三尖瓣峡部消融或同时进行肺静脉隔离。所有患者均植入了可穿戴式心脏监测器。
50名患者完成了试验，且患者匹配良好。峡部消融在所有患者中均成功；肺静脉隔离在25名（100%）随机分组患者中成功。联合消融组的手术时间（P <.0001）和透视时间（P <.0001）更长。仅峡部消融组在随访期间有更多患者出现新发房颤（52%对12%；P =.003）。与仅峡部消融组相比，联合消融组的1年房颤负荷也更低（8.3%对4.0%；P =.034）。在仅峡部消融组中，8名（32%）患者随后因房颤接受了另一次消融。肺静脉隔离的实施和男性性别是无房颤的独立预测因素。
在PREVENT-AF研究I中，对临床上仅观察到典型AFL的患者进行随机临床试验，在三尖瓣峡部消融的基础上加用肺静脉隔离，通过连续植入式心脏监测器评估，在临床随访期间新发房颤显著减少。
