Kyung Hee University Medical College, Seoul, Republic of Korea.
Korea University Cardiovascular Center, Seoul, Republic of Korea.
JACC Clin Electrophysiol. 2019 Nov;5(11):1253-1261. doi: 10.1016/j.jacep.2019.08.021. Epub 2019 Oct 30.
This study explored whether complete electrical isolation of the left atrial (LA) posterior wall improves the rhythm outcome of catheter ablation of persistent atrial fibrillation (AF).
Although the STAR AF2 (Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II) proved no additional benefit of empirical extra-pulmonary vein (PV) LA ablation, the long-term recurrence rate after circumferential PV isolation (CPVI) alone remains high.
We randomly assigned 217 patients with persistent AF (83.1% men, age 58.7 ± 10.8 years, 73.3% long-standing persistent AF) to ablation with CPVI alone (CPVI group) or CPVI with a POsterior wall Box Isolation (POBI group). The endpoint of the POBI group was the elimination of the posterior atrial potentials by roof and posterior inferior lines and touch-up focal ablation.
After a mean follow-up of 16.2 ± 8.8 months, the clinical recurrence rate did not significantly differ between the 2 groups (23.8% vs. 26.5%; p = 0.779) in the CPVI and POBI groups. The recurrence rate for atrial tachycardias (16.0% vs. 11.1%; p = 0.913) and cardioversion rates (6.7% vs. 13.7%; p = 0.093) to control clinical recurrences also did not significantly differ between the 2 groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 50.5% and 55.9% in the CPVI and POBI groups, respectively (p = 0.522). No significant difference was found in the major complication rates between the 2 groups, but the total ablation time was significantly longer in the POBI group (4,289 ± 1,837 s vs. 5,365 ± 2,358 s; p < 0.001).
In patients with persistent AF, an empirical complete POBI did not improve the rhythm outcome of catheter ablation or influence the type of recurrent atrial arrhythmia. (Comparison of Circumferential Pulmonary Vein Isolation Alone Versus Linear Ablation in Addition to Circumferential Pulmonary Vein Isolation for Catheter Ablation in Persistent Atrial Fibrillation: Prospective Randomized Controlled Trial; NCT02721121).
本研究旨在探讨左心房（LA）后壁的完全电隔离是否能改善持续性心房颤动（AF）导管消融的节律转归。
尽管 STAR AF2（基质和触发消融以减少心房颤动试验第二部分）证实了经验性额外肺静脉（PV）LA 消融并无额外获益，但单纯环 PV 隔离（CPVI）后的长期复发率仍然很高。
我们随机将 217 例持续性 AF 患者（83.1%为男性，年龄 58.7±10.8 岁，73.3%为长程持续性 AF）分为 CPVI 组（CPVI 组）或 CPVI 加后侧壁 Box 隔离（POBI 组）。POBI 组的终点是通过屋顶和后下线路以及触发性消融消除后房电位。
在平均 16.2±8.8 个月的随访后，CPVI 组和 POBI 组的临床复发率无显著差异（23.8% vs. 26.5%；p=0.779）。心房心动过速（16.0% vs. 11.1%；p=0.913）和电复律率（6.7% vs. 13.7%；p=0.093）以控制临床复发率在两组之间也无显著差异。在最后一次随访时，CPVI 组和 POBI 组分别有 50.5%和 55.9%的患者在未使用抗心律失常药物的情况下维持窦性心律（p=0.522）。两组间主要并发症发生率无显著差异，但 POBI 组的总消融时间明显较长（4,289±1,837s vs. 5,365±2,358s；p<0.001）。
在持续性 AF 患者中，经验性完全 POBI 并不能改善导管消融的节律转归，也不能影响复发性房性心律失常的类型。（环 PV 隔离单独与环 PV 隔离加线性消融治疗持续性心房颤动的比较：前瞻性随机对照试验；NCT02721121）。
