Grieco Domenico, Palamà Zefferino, Borrelli Alessio, De Ruvo Ermenegildo, Sciarra Luigi, Scarà Antonio, Goanta Emilia, Calabrese Vito, Pozzilli Paolo, Di Sciascio Germano, Calò Leonardo
1 Cardiology Unit, Policlinico Casilino, Rome, Italy.
2 Institutul De Boli Cardiovasculare Timisoara, Timisoara, Romania.
Diab Vasc Dis Res. 2018 May;15(3):185-195. doi: 10.1177/1479164117752492. Epub 2018 Jan 16.
Complex fractionated atrial electrograms (CFAEs) are related to atrial fibrosis, but their ablation has not yet shown superiority. The aim of the study was to compare, in terms of clinical outcome, two strategies of paroxysmal atrial fibrillation (AF) ablation in patients with type 1 diabetes mellitus (DM): pulmonary vein isolation (PVI) vs. PVI + CFAEs. Compared to an historical population of patient with paroxysmal AF and without DM, a higher percentage of patients with DM showed more than 25% of atrial area interested by CFAEs (study population, 58% vs historical group, 15%; p < 0.05). In PVI group, recurrences rate was similar in patients with HbA1c ⩽ 7.5% vs HbA1c > 7.5% (30% vs 22%; p = not significant), but a greater AF burden was observed in patients with HbA1c > 7.5% (6 ± 2 vs 1 ± 2; p < 0.05). In hazard ratios analysis PVI+CFAEs seems more effective than PVI alone in patients with HbA1c > 7.5% (hazard ratio, 1.28; p < 0.05), more than 25 years from DM diagnosis (hazard ratio, 1.25; p < 0.05) and more than five AF episodes/year (hazard ratio, 1.2; p < 0.05). Type 1 DM patients had complex atrial 'substrate', as documented by wider CFAEs areas. Despite this, 1-year follow-up recurrence rate was similar between two ablation approaches (PVI 27% vs. PVI+CFAEs 21%; p = not significant). In our study, only specific subgroups, like patients with disglycaemic state (HbA1c > 7.5%), long diabetes mellitus history and high AF burden, benefit from PVI+ CFAEs approach.
复杂碎裂心房电图（CFAEs）与心房纤维化有关，但其消融尚未显示出优势。本研究的目的是比较1型糖尿病（DM）患者阵发性心房颤动（AF）消融的两种策略在临床结局方面的差异：肺静脉隔离（PVI）与PVI+CFAEs。与阵发性AF且无DM的历史患者群体相比，DM患者中CFAEs累及心房面积超过25%的比例更高（研究群体为58%，历史组为15%；p<0.05）。在PVI组中，糖化血红蛋白（HbA1c）≤7.5%的患者与HbA1c>7.5%的患者复发率相似（30%对22%；p=无统计学意义），但HbA1c>7.5%的患者房颤负荷更大（6±2对1±2；p<0.05）。在风险比分析中，对于HbA1c>7.5%的患者（风险比为1.28；p<0.05）、DM诊断超过25年的患者（风险比为1.25；p<0.05）以及每年房颤发作超过5次的患者（风险比为1.2；p<0.05），PVI+CFAEs似乎比单独的PVI更有效。1型DM患者具有复杂的心房“基质”，这通过更广泛的CFAEs区域得以证实。尽管如此，两种消融方法的1年随访复发率相似（PVI为27%，PVI+CFAEs为21%；p=无统计学意义）。在我们的研究中，只有特定亚组，如血糖控制不佳（HbA1c>7.5%）、糖尿病病史长且房颤负荷高的患者，从PVI+CFAEs方法中获益。
