Intermountain Medical Center Heart Institute, Intermountain Medical Center, Salt Lake City, Utah; Department of Internal Medicine, Stanford University, Stanford, California.
Intermountain Medical Center Heart Institute, Intermountain Medical Center, Salt Lake City, Utah.
Heart Rhythm. 2020 Feb;17(2):184-189. doi: 10.1016/j.hrthm.2019.08.001. Epub 2019 Aug 6.
High power, shorter duration (HPSD) ablation strategies have been advocated to increase efficacy and minimize posterior wall deep tissue thermal injury during atrial fibrillation (AF) ablation.
The purpose of this study was to determine the long-term outcomes of arrhythmia-free survival from AF and atrial flutter (AFL) between HPSD and low power, longer duration (LPLD) ablation strategies.
Of a total of 1333 first time AF ablation procedures with 3 years of follow-up, propensity-matched populations for baseline risk factors were created, comprising 402 patients treated with LPLD ablation (30 W for 5 seconds: posterior wall; 30 W for 10-20 seconds: anterior wall) and 402 patients treated with HPSD ablation (50 W for 2-3 seconds: posterior wall; 50 W for 5-15 seconds: anterior wall). AF/AFL outcomes after a 90-day blanking period were assessed.
HPSD ablation was associated with shorter procedure and fluoroscopy times (P < .0001 for both). The recurrence of AF at 1 year (12.9% vs 16.2%; P = .19) and 3 years (26.5% vs 30.7%; P = .23) was similar between LPLD and HPSD groups. AFL was higher at 1 year (7.2% vs 11.2%; P = .03) and 3 years (16.1% vs 21.8%; P = .06; P = .04 after multivariate adjustment) with HPSD ablation. Patients who underwent an LPLD approach had lower rates of need for repeat ablation (21% vs 30%; P = .002).
Long-term freedom from AF rates were not significantly different between both approaches. An HPSD ablation strategy compared with an LPLD approach was associated with an increased risk of AFL and need for repeat ablation but with lowered procedure times.
高功率、短持续时间（HPSD）消融策略已被提倡用于提高疗效并最小化心房颤动（AF）消融期间后壁深部组织热损伤。
本研究旨在确定 HPSD 与低功率、长持续时间（LPLD）消融策略之间 AF 无心律失常生存和房扑（AFL）的长期结果。
在总共 1333 例首次 AF 消融术和 3 年随访中，根据基线风险因素创建了倾向匹配的人群，包括 402 例接受 LPLD 消融治疗的患者（后壁 30 W 5 秒：后壁；30 W 10-20 秒：前壁）和 402 例接受 HPSD 消融治疗的患者（后壁 50 W 2-3 秒：后壁；前壁 50 W 5-15 秒）。评估 90 天空白期后的 AF/AFL 结果。
HPSD 消融与较短的手术和透视时间相关（两者均 P <.0001）。LPLD 和 HPSD 组 1 年（12.9% vs 16.2%；P =.19）和 3 年（26.5% vs 30.7%；P =.23）的 AF 复发率相似。HPSD 消融后 1 年（7.2% vs 11.2%；P =.03）和 3 年（16.1% vs 21.8%；P =.06；多变量调整后 P =.04）的 AFL 较高。接受 LPLD 方法的患者再次消融的需求率较低（21% vs 30%；P =.002）。
两种方法之间的 AF 无复发率无显著差异。与 LPLD 方法相比，HPSD 消融策略与 AFL 风险增加和需要再次消融相关，但手术时间缩短。
