Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea (H.-N.P., J.-W.P., S.-Y.Y., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L.).
Department of Cardiology, Ewha Womans University Medical Center, Seoul, Republic of Korea (J.P.).
Circ Arrhythm Electrophysiol. 2020 Sep;13(9):e008531. doi: 10.1161/CIRCEP.120.008531. Epub 2020 Jul 28.
Persistent atrial fibrillation (AF) can change to paroxysmal AF after antiarrhythmic drug medication and cardioversion. We investigated whether electrical posterior box isolation (POBI) may improve rhythm outcome of catheter ablation in those patient groups.
We prospectively randomized 114 patients with persistent AF to paroxysmal AF (men, 75%; 59.8±9.9 years old) to circumferential pulmonary vein isolation (CPVI) alone group (n=57) and additional POBI group (n=57). Primary end point was AF recurrence after a single procedure, and secondary end points were recurrence pattern, cardioversion rate, and response to antiarrhythmic drugs.
After a mean follow-up of 23.8±10.2 months, the clinical recurrence rate did not significantly differ between the CPVI alone and additional POBI group (31.6% versus 28.1%; =0.682; log-rank =0.729). The recurrences as atrial tachycardias (5.3% versus 12.3%; =0.134) and cardioversion rates (5.3% versus 10.5%; =0.250) were not significantly different between the CPVI and POBI groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 52.6% of CPVI group and 59.6% of POBI group (=0.450). No significant difference was found in major complication rates between the two groups (5.3% versus 1.8%; =0.618), but the total ablation time was significantly longer in the POBI group (4187±952 versus 5337±1517 s; <0.001).
In patients with persistent AF converted to paroxysmal AF by antiarrhythmic drug, the addition of POBI to CPVI did not improve the rhythm outcome of catheter ablation or influence overall safety, while leading to longer ablation time. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02176616.
抗心律失常药物治疗和电复律后，持续性心房颤动（AF）可转为阵发性 AF。我们研究了电后箱隔离（POBI）是否可能改善这些患者群体导管消融的节律结果。
我们前瞻性地将 114 名持续性 AF 转为阵发性 AF 的患者（男性占 75%；59.8±9.9 岁）随机分为单纯环肺静脉隔离（CPVI）组（n=57）和附加 POBI 组（n=57）。主要终点是单次手术后 AF 复发，次要终点是复发模式、电复律率和抗心律失常药物反应。
平均随访 23.8±10.2 个月后，CPVI 组和附加 POBI 组的临床复发率无显著差异（31.6%比 28.1%；=0.682；对数秩=0.729）。CPVI 组和 POBI 组的复发作为房性心动过速（5.3%比 12.3%；=0.134）和电复律率（5.3%比 10.5%；=0.250）无显著差异。在最终随访时，CPVI 组 52.6%和 POBI 组 59.6%的患者无抗心律失常药物维持窦性节律（=0.450）。两组之间主要并发症发生率无显著差异（5.3%比 1.8%；=0.618），但 POBI 组的总消融时间明显更长（4187±952 比 5337±1517 s；<0.001）。
在抗心律失常药物转复为阵发性 AF 的持续性 AF 患者中，CPVI 加 POBI 并不能改善导管消融的节律结果，也不会影响整体安全性，反而会导致消融时间延长。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT02176616。
