Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 West Huaihai Road, Xuhui District, Shanghai 200030, China.
Europace. 2021 May 21;23(5):701-709. doi: 10.1093/europace/euaa314.
The aim of this study was to determine whether driver ablation effectively treats persistent atrial fibrillation (AF) in obese patients.
We randomly assigned 124 persistent AF obese patients to two groups, one undergoing conventional ablation (n = 62) and the other undergoing driver ablation (n = 62). Sixty-two non-obese patients with persistent AF undergoing driver ablation served as matched controls. Bipolar electrogram dispersion was analysed for driver mapping. Epicardial adipose tissue (EAT) volume was measured using cardiac computed tomography. Obese patients had a higher proportion of driver regions in the posterior wall (56.5% vs. 32.3%, P = 0.007). Driver complexity, measured as the average number and area of driver regions, was higher in the obese group than in the non-obese group (3.5 ± 1.0 vs. 2.9 ± 0.9, P < 0.001; 15.5% ± 4.2% vs. 9.8 ± 2.6%, P < 0.001, respectively). Left atrial EAT volume correlated better with the proportion of area of driver regions than did body mass index (BMI) and total EAT (BMI: r2 = 0.250, P < 0.001; total EAT: r2 = 0.379, P < 0.001; and left atrial EAT: r2 = 0.439, P < 0.001). The rate of AF termination was significantly higher in the driver ablation group than in the conventional ablation group (82.9% vs. 22.8%, P < 0.001). During the follow-up period of 16.9 ± 6.5 months, patients in the driver ablation group had significantly better AF-free survival (91.91% vs. 79.0%, log rank test, P = 0.026) and AF/atrial tachycardia-free survival (83.9% vs. 64.5%, log rank test, P = 0.011) than did patients in the conventional ablation group.
Obesity is associated with increased driver complexity. Driver ablation improves long-term outcomes in obese patients with persistent AF.
本研究旨在确定消融是否能有效治疗肥胖患者持续性心房颤动（房颤）。
我们将 124 例持续性肥胖房颤患者随机分为两组，一组进行常规消融（n=62），另一组进行驱动消融（n=62）。62 例非肥胖持续性房颤患者接受驱动消融作为匹配对照组。进行驱动标测分析双极电图离散度。使用心脏计算机断层扫描测量心外膜脂肪组织（EAT）体积。肥胖患者后壁驱动区域的比例较高（56.5%比 32.3%，P=0.007）。与非肥胖组相比，肥胖组的驱动复杂性更高，表现为驱动区域的平均数量和面积更高（3.5±1.0比 2.9±0.9，P<0.001；15.5%±4.2%比 9.8%±2.6%，P<0.001）。左心房 EAT 体积与驱动区域面积比例的相关性优于 BMI 和总 EAT（BMI：r2=0.250，P<0.001；总 EAT：r2=0.379，P<0.001；左心房 EAT：r2=0.439，P<0.001）。驱动消融组的房颤终止率明显高于常规消融组（82.9%比 22.8%，P<0.001）。在 16.9±6.5 个月的随访期间，驱动消融组患者的无房颤生存率（91.91%比 79.0%，对数秩检验，P=0.026）和无房颤/房性心动过速生存率（83.9%比 64.5%，对数秩检验，P=0.011）明显高于常规消融组。
肥胖与驱动复杂性增加有关。驱动消融可改善肥胖持续性房颤患者的长期预后。
