Department of Cardiology, OLVG, Amsterdam, The Netherlands.
Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
J Cardiovasc Electrophysiol. 2022 May;33(5):885-896. doi: 10.1111/jce.15441. Epub 2022 Mar 22.
Approximately 18% of patients with atrial fibrillation (AF) undergo a repeat ablation within 12 months after their index ablation. Despite the high prevalence, comparative studies on nonpulmonary vein (PV) target strategies in repeat AF ablation are scarce. Here, we describe 12 months efficacy of non-PV and PV target ablations as a repeat ablation strategy.
A multicentre retrospective, descriptive study was conducted with data of 280 patients who underwent repeat AF ablation. The ablation strategy for repeat ablation was at the operators' discretion. Non-PV target ablation (n = 140) included PV reisolation, posterior wall isolation, mitral line, roofline, and/or complex fractionated atrial electrogram ablation. PV target ablation (n = 140), included reisolation and/or wide atrium circumferential ablation. Patients' demographics and rhythm outcomes during 12 months follow-up were analyzed.
At 12 months, more atrial tachyarrhythmias were observed in the non-PV target group (48.6%) compared to the PV target group (29.3%, p = .001). Similarly, a significantly higher AF and atrial tachycardia (AT) recurrence rate was observed after non-PV target ablation compared to PV target ablation (36.4% vs. 22.1% and 22.9% vs. 10.7%). After adjustment, a significantly higher risk of AT recurrence remained in the non-PV target group. Both groups significantly de-escalated antiarrhythmic drug use; de-escalation was more profound after PV target ablation. Patients with isolated PVs during non-PV target ablation had a significantly higher risk for AF recurrence than those with reconnected PVs.
Compared to PV target ablation, non-PV target repeat ablation did not improve outcomes after 12 months and was independently associated with an increased risk for AT recurrences.
大约 18%的心房颤动（AF）患者在索引消融后 12 个月内再次进行消融。尽管患病率很高，但关于重复 AF 消融中非肺静脉（PV）靶点策略的比较研究却很少。在此，我们描述了作为重复消融策略的非 PV 和 PV 靶点消融 12 个月的疗效。
进行了一项多中心回顾性描述性研究，共纳入 280 名接受重复 AF 消融的患者数据。重复消融的消融策略由操作者自行决定。非 PV 靶点消融（n=140）包括 PV 再隔离、后墙隔离、二尖瓣线、房顶线和/或复杂碎裂心房电图消融。PV 靶点消融（n=140）包括再隔离和/或广泛心房环周消融。分析了患者的人口统计学数据和 12 个月随访期间的节律结果。
在 12 个月时，非 PV 靶点组（48.6%）比 PV 靶点组（29.3%）观察到更多的房性心动过速（p=0.001）。同样，与 PV 靶点消融相比，非 PV 靶点消融后 AF 和房性心动过速（AT）复发率明显更高（36.4%比 22.1%和 22.9%比 10.7%）。校正后，非 PV 靶点组的 AT 复发风险仍然显著升高。两组均显著减少抗心律失常药物的使用；PV 靶点消融后药物减量更明显。在非 PV 靶点消融中孤立的 PV 与有再连接的 PV 相比，AF 复发的风险显著增加。
与 PV 靶点消融相比，非 PV 靶点重复消融在 12 个月后并不能改善结果，并且与 AT 复发的风险增加独立相关。
