Sousa Pedro A, Puga Luís, Adão Luís, Primo João, Khoueiry Ziad, Lebreiro Ana, Fonseca Paulo, Lagrange Philippe, Elvas Luís, Gonçalves Lino
Pacing & Electrophysiology Unit, Cardiology Department Coimbra's Hospital and University Center Coimbra Portugal.
Cardiology Department University Hospital Center of São João Porto Portugal.
J Arrhythm. 2022 Mar 15;38(3):346-352. doi: 10.1002/joa3.12696. eCollection 2022 Jun.
The use of the Ablation Index (AI) software for paroxysmal atrial fibrillation (AF) has been associated with higher acute effectiveness and higher 1-year arrhythmia freedom. There is, however, a lack of data concerning longer follow-up. We aim to evaluate the 2-year outcomes after a standardized AI-guided pulmonary vein isolation (PVI).
Prospective, multicenter study of consecutive patients referred for paroxysmal AF ablation from January 2018 to July 2019. PVI was guided by a tailored AI value (≥500 for anterior segment, ≥450 for the roof segments and inferior segments, and 400 for the posterior wall) and an ILD ≤6 mm. The primary endpoints were acute and long-term effectiveness.
The study included 218 (842 PV) patients (61% males, median age of 60 [IQR 49-68] years) with paroxysmal AF. First-pass isolation was obtained in 93% of the patients, with an acute reconnection occurring in 10.6% of the patients (3.2% of the PV) following adenosine trial. After a median follow-up of 26 (IQR 20-30) months, freedom from any documented atrial arrhythmia was 83.4%, off-AAD. The rate of adverse events was 1.4%. Although procedural parameters differ across centers ( < 0.001), the acute ( = 0.56) and long-term effectiveness ( = 0.83) were consistent between centers.
Patients with paroxysmal AF submitted to an AI-guided PVI workflow presented high arrhythmia freedom at 2-years of follow-up.
使用消融指数（AI）软件治疗阵发性心房颤动（AF）与更高的急性有效性和更高的1年心律失常无复发率相关。然而，关于更长随访期的数据尚缺乏。我们旨在评估标准化AI引导下肺静脉隔离（PVI）后的2年结局。
对2018年1月至2019年7月因阵发性AF消融而转诊的连续患者进行前瞻性、多中心研究。PVI由定制的AI值（前段≥500，顶部段和下段≥450，后壁为400）和≤6mm的食管-肺静脉距离（ILD）引导。主要终点是急性和长期有效性。
该研究纳入了218例（842条肺静脉）阵发性AF患者（61%为男性，中位年龄60[四分位间距49 - 68]岁）。93%的患者实现首次隔离，腺苷试验后10.6%的患者（3.2%的肺静脉）出现急性再连接。中位随访26（四分位间距20 - 30）个月后，无任何记录的房性心律失常且停用抗心律失常药物（AAD）的比例为83.4%。不良事件发生率为1.4%。尽管各中心的手术参数不同（<0.001），但各中心之间的急性（=0.56）和长期有效性（=0.83）是一致的。
接受AI引导的PVI工作流程的阵发性AF患者在2年随访时心律失常无复发率高。
