Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London.
J Cardiovasc Electrophysiol. 2021 Feb;32(2):200-209. doi: 10.1111/jce.14856. Epub 2021 Jan 9.
The optimal ablation approach for persistent atrial fibrillation (AF) remains unclear.
Objective was to compare the long-term rates of freedom from AF/AT in patients that underwent STAR mapping guided ablation against outcomes of patients undergoing conventional ablation procedures. Patients undergoing ablation for persistent AF as part of the Stochastic Trajectory Analysis of Ranked signals (STAR) mapping study were included. Outcomes following 'pulmonary vein isolation (PVI) plus STAR mapping guided ablation (STAR mapping cohort) were compared to patients undergoing PVI alone ablation during the same time period and also a propensity-matched cohort undergoing PVI plus the addition of complex fractionated electrogram (CFAE) and/or linear ablation ("conventional ablation"). Rates of procedural AF termination and freedom from AF/AT during follow-up were compared. Sixty-five patients were included in both the STAR cohort and propensity matched conventional ablation cohort. AF termination rates were significantly higher in the STAR cohort (51/65, 78.5%) than conventional ablation cohort (10/65, 15.4%) and PVI alone ablation cohort (13/50, 26.0%; STAR cohort vs. other 2 cohorts both p < .001). There was no significant difference in procedure time between the three cohorts. During ≥20 months follow-up a lower proportion of patients had AF/AT recurrence in the STAR cohort (20.0%) compared with the conventional ablation cohort (50.8%) or the PVI alone ablation cohort (50.0%; both p < .05 compared to STAR cohort).
Outcomes of PVI plus STAR mapping guided ablation was superior to PVI alone or in combination with linear/CFAE ablation. A multicenter randomized controlled trial is planned to confirm these findings.
持续性心房颤动(AF)的最佳消融方法仍不清楚。
本研究旨在比较 STAR 图谱引导消融与常规消融患者持续性 AF 消融后无 AF/AT 的长期比率。纳入接受 STAR 图谱消融治疗持续性 AF 的患者。比较 STAR 图谱引导消融(STAR 图谱组)后与同期行单纯肺静脉隔离(PVI)消融及倾向匹配行 PVI 联合复杂碎裂电图(CFAE)和/或线性消融(“常规消融”)患者的结果。比较术后即刻和随访期间的 AF 终止率及 AF/AT 无复发率。STAR 图谱组和倾向匹配常规消融组均纳入 65 例患者。STAR 图谱组的 AF 终止率(51/65,78.5%)明显高于常规消融组(10/65,15.4%)和单纯 PVI 消融组(13/50,26.0%;STAR 图谱组与其他 2 组比较均 p < .001)。3 组间手术时间无显著差异。在≥20 个月的随访中,STAR 图谱组的 AF/AT 复发率明显低于常规消融组(50.8%)和单纯 PVI 消融组(50.0%;均与 STAR 图谱组比较 p < .05)。
PVI 联合 STAR 图谱引导消融的疗效优于单纯 PVI 或 PVI 联合线性/CFAE 消融。计划进行多中心随机对照试验以证实这些发现。