Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A., J.P.P.).
Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, and Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.).
Circulation. 2020 Feb 11;141(6):482-492. doi: 10.1161/CIRCULATIONAHA.119.042706. Epub 2019 Nov 20.
Catheter ablation has brought major advances in the management of patients with atrial fibrillation (AF). As evidenced by multiple randomized trials, AF catheter ablation can reduce the risk of recurrent AF and improve quality of life. In some studies, AF ablation significantly reduced cardiovascular hospitalizations. Despite the existing data on AF catheter ablation, numerous knowledge gaps remain concerning this intervention. This report is based on a recent virtual workshop convened by the National Heart, Lung, and Blood Institute to identify key research opportunities in AF ablation. We outline knowledge gaps related to emerging technologies, the relationship between cardiac structure and function and the success of AF ablation in patient subgroups in whom clinical benefit from ablation varies, and potential platforms to advance clinical research in this area. This report also considers the potential value and challenges of a sham ablation randomized trial. Prioritized research opportunities are identified and highlighted to empower relevant stakeholders to collaborate in designing and conducting effective, cost-efficient, and transformative research to optimize the use and outcomes of AF ablation.
导管消融技术在心房颤动(房颤)患者的治疗中取得了重大进展。多项随机试验证明,房颤导管消融术可以降低房颤复发的风险,提高生活质量。在一些研究中,房颤消融术显著减少了心血管住院治疗。尽管有关于房颤导管消融术的现有数据,但对于这种干预措施仍存在许多知识空白。本报告基于美国国立心肺血液研究所最近召开的一次虚拟研讨会,旨在确定房颤消融术的关键研究机会。我们概述了与新兴技术、心脏结构和功能之间的关系以及在消融获益因患者亚组而异的情况下,房颤消融术成功相关的知识空白,以及推进该领域临床研究的潜在平台。本报告还考虑了假消融随机试验的潜在价值和挑战。确定了优先研究机会,并强调赋予相关利益攸关方权力,以合作设计和开展有效、具有成本效益和变革性的研究,优化房颤消融术的使用和结果。