Yonsei University Health System, Seoul, Republic of Korea.
Yonsei University Health System, Seoul, Republic of Korea.
JACC Clin Electrophysiol. 2022 May;8(5):582-592. doi: 10.1016/j.jacep.2022.01.003. Epub 2022 Feb 23.
This study investigated whether additional electrical posterior box isolation (POBI) may improve the rhythm outcome of repeat ablation in atrial fibrillation (AF).
Although electrically reconnected pulmonary veins (PVs) are the main mechanism of AF recurrence, it is unclear whether linear ablation in addition to circumferential PV isolation (CPVI) improves rhythm outcomes after repeat ablation.
The authors prospectively randomized 150 patients with PV reconnection undergoing redo procedures to either a CPVI-alone group (n = 75) or an additional POBI group (n = 75). The primary endpoint was AF recurrence after a single procedure, and the secondary endpoints were recurrence pattern, cardioversion rate, and response to antiarrhythmic drugs.
After a median follow-up of 17 months, the clinical recurrence rate did not significantly differ between the CPVI-alone and additional-POBI groups (30.7% vs 30.7%; log-rank P =0.828). Of the 46 patients with clinical recurrence, the recurrences as atrial tachycardia (8.7% vs 30.4%; P =0.137) and cardioversion rates (21.7% vs 47.8%; P =0.122) were not significantly different between the CPVI-alone and additional-POBI groups. Major complication rates did not differ between the 2 groups (1.3% vs 5.3%; P = 0.363), but the total ablation time was significantly longer in the additional-POBI group than in the CPVI-alone group (median: 1,084 [IQR: 704-1,664] vs 1,595 [IQR: 1,244-2,302] seconds; P < 0.001).
Among patients undergoing redo AF ablation with reconnected PVs, the addition of POBI to CPVI did not improve rhythm outcomes or influence overall safety, whereas leading to a longer ablation time than that with CPVI alone. (Comparison of Circumferential Pulmonary Vein Isolation and Complex Pulmonary Vein Isolation Additional Linear Ablation for Recurred Atrial Fibrillation After Previous Catheter Ablation: Prospective Randomized Trial [RILI Trial]; NCT02747498).
本研究旨在探讨在心房颤动（房颤）患者中，额外的电后箱隔离（POBI）是否可以改善重复消融的节律结果。
尽管电再连接的肺静脉（PVs）是房颤复发的主要机制，但尚不清楚环肺静脉隔离（CPVI）外加线性消融是否可以改善重复消融后的节律结果。
作者前瞻性地将 150 名 PV 再连接患者随机分为 CPVI 组（n=75）或额外 POBI 组（n=75）。主要终点是单次手术后的房颤复发，次要终点是复发模式、电复律率和抗心律失常药物的反应。
中位随访 17 个月后，CPVI 组和额外 POBI 组的临床复发率无显著差异（30.7%比 30.7%；log-rank P=0.828）。在 46 例临床复发的患者中，CPVI 组和额外 POBI 组的复发为房性心动过速（8.7%比 30.4%；P=0.137）和电复律率（21.7%比 47.8%；P=0.122）无显著差异。两组的主要并发症发生率无差异（1.3%比 5.3%；P=0.363），但额外 POBI 组的总消融时间明显长于 CPVI 组（中位数：1084[IQR：704-1664]比 1595[IQR：1244-2302]秒；P<0.001）。
在接受 PV 再连接的复发性房颤消融的患者中，CPVI 外加 POBI 并不能改善节律结果或影响总体安全性，反而导致消融时间长于 CPVI 单独治疗。（比较环肺静脉隔离和复杂肺静脉隔离附加线性消融对以前导管消融后复发的心房颤动的影响：前瞻性随机试验[RILI 试验]；NCT02747498）。
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