Texas Cardiac Arrhythmia Institute, Austin, Texas, USA.
Dell Medical School, Austin, Texas, USA.
JACC Clin Electrophysiol. 2021 Mar;7(3):308-318. doi: 10.1016/j.jacep.2020.08.035. Epub 2020 Nov 25.
This study evaluated the association of the post-ablation scar with stroke risk in patients undergoing atrial fibrillation (AF) ablation.
Late gadolinium enhancement-cardiac magnetic resonance studies have reported a direct association between pre-ablation left atrial scar and thromboembolic events in patients with AF.
Consecutive patients with AF were classified into 2 groups based on the type of ablation performed at the first procedure. Group 1 involved limited ablation (isolation of pulmonary veins, left atrial posterior wall, and superior vena cava); and group 2 involved extensive ablation (limited ablation + ablation of nonpulmonary vein triggers from all sites except left atrial appendage). During the repeat procedure, post-ablation scar (region with bipolar voltage amplitude <0.5 mV) was identified by using 3-dimensional voltage mapping.
A total of 6,297 patients were included: group 1, n = 1,713; group 2, n = 4,584. Group 2 patients were significantly older and had more nonparoxysmal AF. Nineteen (0.3%) thromboembolic events were reported after the first ablation procedure: 9 (1.02%) in group 1 and 10 (0.61%) in group 2 (p = 0.26). At the time of the event, all 19 patients were experiencing arrhythmia. Median time to stroke was 14 (interquartile range: 9 to 20) months in group 1 and 14.5 (interquartile range: 8 to 18) months in group 2. Post-ablation scar data were derived from 2,414 patients undergoing repeat ablation. Mean scar area was detected as 67.1 ± 4.6% in group 2 and 34.9 ± 8.8% in group 1 at the redo procedure (p < 0.001).
Differently from the cardiac magnetic resonance-detected pre-ablation scar, scar resulting from extensive ablation was not associated with increased risk of stroke compared with that from the limited ablation.
本研究评估了在行房颤（AF）消融术的患者中，消融后疤痕与中风风险的相关性。
晚期钆增强心脏磁共振研究报告称，在 AF 患者中，消融前左心房疤痕与血栓栓塞事件之间存在直接关联。
根据首次手术中进行的消融类型，连续的 AF 患者被分为 2 组。第 1 组为局限性消融（肺静脉、左心房后壁和上腔静脉隔离）；第 2 组为广泛消融（局限性消融+除左心耳外所有部位的非肺静脉触发灶消融）。在重复手术过程中，通过使用 3 维电压图识别消融后疤痕（双极电压幅度<0.5 mV 的区域）。
共纳入 6297 例患者：第 1 组 n=1713 例，第 2 组 n=4584 例。第 2 组患者年龄明显较大，且非阵发性 AF 较多。首次消融术后报告了 19 例（0.3%）血栓栓塞事件：第 1 组 9 例（1.02%），第 2 组 10 例（0.61%）（p=0.26）。在事件发生时，所有 19 例患者均有心律失常。第 1 组的中位中风时间为 14 个月（四分位距：9 至 20），第 2 组为 14.5 个月（四分位距：8 至 18）。在 2414 例接受重复消融的患者中获得了消融后疤痕数据。在再次手术中，第 2 组的平均疤痕面积为 67.1±4.6%，第 1 组为 34.9±8.8%（p<0.001）。
与心脏磁共振检测到的消融前疤痕不同，广泛消融导致的疤痕与局限性消融相比，与中风风险增加无关。
