Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku Saitama 330-8553, Japan.
Department of Cardiovascular Medicine, Tokyo Medical & Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Europace. 2022 Nov 22;24(11):1769-1776. doi: 10.1093/europace/euac079.
The efficacy of left atrial posterior wall isolation (PWI) is controversial. Lesion durability may be a major cause of arrhythmia recurrence. The use of the lesion size prediction module improves lesion durability. This study aimed to compare the clinical outcomes of pulmonary vein isolation (PVI) alone and PWI in addition to PVI (PVI + PWI) in patients with non-paroxysmal atrial fibrillation (AF) using a lesion size prediction module.
This study is a sub-analysis of the recently published prospective multicentre observational study called ALCOHOL-AF (association of alcohol consumption with outcome of catheter ablation of AF). In this sub-analysis, patients with non-paroxysmal AF in whom PVI alone or PVI + PWI was performed using the lesion size prediction module were included. Freedom from atrial tachyarrhythmia was compared between PVI alone and PVI + PWI groups using propensity score analyses. Of the 3474 patients registered in the ALCOHOL-AF study, 572 patients (age 65.6 ± 10.1 years, male 77.4%, longstanding persistent AF 25.5%) were included in this sub-analysis. We selected 212 patients treated with PVI alone and 212 treated with PVI + PWI using one-to-one propensity score matching. During the follow-up period, atrial tachyarrhythmia recurrence was documented in 92 (43.4%) and 50 (23.6%) patients in the PVI alone and PVI + PWI groups, respectively. Freedom from atrial tachyarrhythmia recurrence without anti-arrhythmic drugs after a single procedure was significantly higher in PVI + PWI than in PVI alone groups (hazard ratio: 0.452, 95% confidence interval: 0.308-0.664, P < 0.001).
In this hypothesis-generating study, lesion size prediction module-guided PVI + PWI was associated with better clinical outcomes than PVI alone in patients with persistent or longstanding persistent AF.
左心房后壁隔离（PWI）的疗效存在争议。病灶耐久性可能是心律失常复发的主要原因。使用病灶大小预测模块可以提高病灶耐久性。本研究旨在比较使用病灶大小预测模块的单纯肺静脉隔离（PVI）与 PVI 加 PWI（PVI+PWI）治疗非阵发性心房颤动（AF）患者的临床疗效。
本研究是最近发表的前瞻性多中心观察研究“ALCOHOL-AF（酒精摄入与 AF 导管消融结果的关系）”的亚分析。在这项亚分析中，纳入了使用病灶大小预测模块行单纯 PVI 或 PVI+PWI 的非阵发性 AF 患者。采用倾向评分分析比较单纯 PVI 与 PVI+PWI 组的无房性快速心律失常发生率。在 ALCOHOL-AF 研究中登记的 3474 例患者中，有 572 例（年龄 65.6±10.1 岁，男性 77.4%，持续性或长持续性 AF 25.5%）被纳入本亚分析。我们采用 1:1 倾向评分匹配，选择 212 例单纯行 PVI 治疗的患者和 212 例行 PVI+PWI 治疗的患者。在随访期间，单纯 PVI 组和 PVI+PWI 组分别有 92（43.4%）和 50（23.6%）例患者发生房性快速心律失常复发。单次手术后无抗心律失常药物的无房性快速心律失常复发率在 PVI+PWI 组显著高于 PVI 组（风险比：0.452，95%置信区间：0.308-0.664，P<0.001）。
在这项探索性研究中，与单纯 PVI 相比，使用病灶大小预测模块指导的 PVI+PWI 治疗持续性或长持续性 AF 患者的临床疗效更好。
