Ammar-Busch Sonia, Bourier Felix, Reents Tilko, Semmler Verena, Telishevska Marta, Kathan Susanne, Hofmann Monika, Hessling Gabriele, Deisenhofer Isabel
Klinikum Coburg, Coburg, Germany.
Department of Electrophysiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
J Cardiovasc Electrophysiol. 2017 Jun;28(6):636-641. doi: 10.1111/jce.13206. Epub 2017 Apr 21.
For persistent atrial fibrillation (AF) ablation, different strategies including complex fractionated atrial electrograms (CFAE) ablation and linear lesions (LL) have been used in addition to pulmonary vein isolation (PVI). However, it is still a matter of debate if extended substrate modification improves long-term outcome. The aim of this study was to determine the benefit of LL in addition to PVI and CFAE ablation regarding freedom from arrhythmia recurrence in patients with persistent AF.
The study was a prospective randomized trial including 90 patients with persistent and longstanding persistent AF. All patients underwent PVI and CFAE ablation. If AF did not terminate to atrial tachycardia (AT) or sinus rhythm, patients were randomized to direct current cardioversion (Group 1; n = 45) or LL (Group 2; n = 45). Primary endpoint was freedom from any atrial arrhythmia off antiarrhythmic drugs at 12 months. (NCT02059369) RESULTS: Baseline characteristics were similar between the two groups with more than half of the patients having structural heart disease. The primary endpoint was reached in 37% in Group 1 (G1) and 16% in Group 2 (G2; P = 0.03). After a total number of 1.4 ± 0.5 (G1) versus 1.7 ± 0.4 (G2; P = 0.01) procedures, freedom from any arrhythmia was reached in 54% in G1 and 65% in G2 (P = 0.35).
In persistent AF ablation, LL in addition to PVI and CFAE show a significantly lower success rate after a single procedure compared to PVI and CFAE. Following LL, significantly more patients needed a reablation to reach a similar success rate during a 12-month follow-up.
对于持续性心房颤动（房颤）消融，除肺静脉隔离（PVI）外，还采用了不同策略，包括碎裂电位（CFAE）消融和线性消融（LL）。然而，扩大基质改良是否能改善长期疗效仍存在争议。本研究的目的是确定在持续性房颤患者中，除PVI和CFAE消融外，LL对于预防心律失常复发的益处。
本研究为前瞻性随机试验，纳入90例持续性和长期持续性房颤患者。所有患者均接受PVI和CFAE消融。如果房颤未终止为房性心动过速（AT）或窦性心律，患者被随机分为直流电复律组（第1组；n = 45）或LL组（第2组；n = 45）。主要终点是12个月时停用抗心律失常药物后无任何房性心律失常。（NCT02059369）结果：两组患者的基线特征相似，超过半数患者患有结构性心脏病。第1组（G1）达到主要终点的比例为37%，第2组（G2）为16%（P = 0.03）。在总共1.4±0.5次（G1）与1.7±0.4次（G2；P = 0.01）手术后，G1组无任何心律失常的比例为54%，G2组为65%（P = 0.35）。
在持续性房颤消融中，与PVI和CFAE相比，PVI和CFAE联合LL在单次手术后的成功率显著降低。在LL治疗后，在12个月的随访期间，需要再次消融以达到相似成功率的患者明显更多。
