肺静脉隔离以降低典型心房扑动消融患者未来发生心房颤动的风险：一项随机试点研究（REDUCE AF）的结果
Pulmonary Vein Isolation to Reduce Future Risk of Atrial Fibrillation in Patients Undergoing Typical Flutter Ablation: Results from a Randomized Pilot Study (REDUCE AF).
作者信息
Mohanty Sanghamitra, Natale Andrea, Mohanty Prasant, DI Biase Luigi, Trivedi Chintan, Santangeli Pasquale, Bai Rong, Burkhardt J David, Gallinghouse G Joseph, Horton Rodney, Sanchez Javier E, Hranitzky Patrick M, Al-Ahmad Amin, Hao Steven, Hongo Richard, Beheiry Salwa, Pelargonio Gemma, Forleo Giovanni, Rossillo Antonio, Themistoclakis Sakis, Casella Michela, Russo Antonio Dello, Tondo Claudio, Dixit Sanjay
机构信息
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
Department of Internal Medicine, Dell Medical School, Austin, Texas, USA.
出版信息
J Cardiovasc Electrophysiol. 2015 Aug;26(8):819-825. doi: 10.1111/jce.12688. Epub 2015 May 26.
BACKGROUND
This study examined incidence of AF following cavotricuspid isthmus (CTI) ablation alone or CTI plus prophylactic pulmonary vein isolation (PVI) in patients presenting with isolated atrial flutter (AFL) with no history of AF.
METHODS AND RESULTS
We enrolled 216 patients with isolated typical atrial flutter and randomized them to CTI alone (group 1, n = 108, 61.2 ± 9.7 year, 75% male) or CTI+PVI ablation (group 2, n = 108, 62.4 ± 9.3 year, 73% male). Insertible loop recorder (ILR) was implanted in 21 and 19 patients from groups 1 and 2, respectively. Remaining patients were monitored with event recorders, ECG, 7-day Holter. Follow-up period was for 18 ± 6 months. Compared to group 1, group 2 had significantly longer procedural duration (75.9 ± 33 min vs. 161 ± 48 min [P < 0.001]) and fluoroscopy time (15.9 ± 12.3 min vs. 56.4+21 min [P < 0.001]). At the end of follow-up, 65 (60.2%) in group 1 and 77 (71.3%) in group 2 were arrhythmia free off-AAD (log-rank P = 0.044). A subgroup analysis was performed with 55 year age cut-off. In the <55 age group the CTI only population had similar success as in CTI+PVI, (21 of 24 [83.3%] vs. 19 of 22 [86.4%], respectively, log-rank P = 0.74). In the ≥55 group, having CTI+PVI showed significantly higher success compared to CTI only; 45 of 84 (53.6%) were AF/AT free in CTI only group versus 58 of 86 (67.4%) with CTI+PVI (log-rank P = 0.029).
CONCLUSION
Prophylactic PVI reduced new-onset AF in patients with lone atrial flutter.
背景
本研究调查了在无房颤病史的孤立性心房扑动（AFL）患者中，单独进行三尖瓣峡部（CTI）消融或CTI加预防性肺静脉隔离（PVI）后房颤的发生率。
方法与结果
我们纳入了216例孤立性典型心房扑动患者，并将他们随机分为单独CTI组（第1组，n = 108，年龄61.2±9.7岁，男性占75%）或CTI + PVI消融组（第2组，n = 108，年龄62.4±9.3岁，男性占73%）。分别在第1组和第2组的21例和19例患者中植入了植入式环路记录仪（ILR）。其余患者使用事件记录仪、心电图、7天动态心电图进行监测。随访期为18±6个月。与第1组相比，第2组的手术时间明显更长（75.9±33分钟对161±48分钟[P < 0.001]）和透视时间更长（15.9±12.3分钟对56.4 + 21分钟[P < 0.001]）。随访结束时，第1组65例（60.2%）和第2组77例（71.3%）在停用抗心律失常药物（AAD）后无心律失常（对数秩检验P = 0.044）。以55岁为年龄分界点进行了亚组分析。在<55岁年龄组中，单纯CTI组与CTI + PVI组的成功率相似（分别为24例中的21例[83.3%]对22例中的19例[86.4%]，对数秩检验P = 0.74）。在≥55岁组中，与单纯CTI相比，CTI + PVI显示出明显更高的成功率；单纯CTI组84例中有45例（53.6%）无房颤/房性心动过速（AT），而CTI + PVI组86例中有58例（67.4%）无房颤/房性心动过速（对数秩检验P = 0.029）。
结论
预防性PVI可降低孤立性心房扑动患者新发房颤的发生率。
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