Dhillon Gurpreet S, Honarbakhsh Shohreh, Graham Adam, Abbass Hakam, Welch Sophie, Daw Holly, Sporton Simon, Providencia Rui, Chow Anthony, Earley Mark J, Lowe Martin, Lambiase Pier D, Schilling Richard J, Hunter Ross J
Department of Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
J Cardiovasc Electrophysiol. 2022 Nov;33(11):2263-2273. doi: 10.1111/jce.15644. Epub 2022 Aug 16.
This prospective trial sought to phenotype persistent atrial fibrillation (AF) based on AF mechanisms using electrocardiographic imaging (ECGI) mapping to determine whether this would predict long-term freedom from arrhythmia after pulmonary vein isolation (PVI).
Patients with persistent AF of <2 years duration underwent cryoballoon PVI. ECGI mapping was performed before PVI to determine potential drivers (PDs) defined as rotational activations completing ≥1.5 revolutions or focal activations. The coprimary endpoint was the association between (1) PD burden (defined as the number of PD occurrences) and (2) PD distribution (defined as the number of segments on an 18-segment model of the atria harboring PDs) with freedom from arrhythmia at 1-year follow up.
Of 100 patients, 97 completed follow up and 52 (53.6%) remained in sinus rhythm off antiarrhythmic drugs. Neither PD burden nor PD distribution predicted freedom from arrhythmia (hazard ratio [HR]: 1.01, 95% confidence interval [CI]: 0.99-1.03, p = .164; and HR: 1.04, 95% CI: 0.91-1.17, p = .591, respectively). Otherwise, the burden of rotational PDs, rotational stability, and the burden of PDs occurring at the pulmonary veins and posterior wall all failed to predict arrhythmia recurrence (all p > .10).
AF mechanisms as determined using ECGI mapping do not predict outcomes after PVI for persistent AF. Further studies using different methodologies to characterize AF mechanisms are warranted (NCT03394404).
这项前瞻性试验旨在基于房颤机制，采用心电图成像（ECGI）标测对持续性房颤（AF）进行表型分析，以确定这是否能预测肺静脉隔离（PVI）术后长期无心律失常。
病程小于2年的持续性房颤患者接受冷冻球囊PVI。在PVI前进行ECGI标测，以确定潜在驱动因素（PDs），定义为完成≥1.5次旋转的旋转激动或局灶性激动。共同主要终点是（1）PD负荷（定义为PD出现的次数）和（2）PD分布（定义为心房18节段模型上存在PD的节段数）与1年随访时无心律失常之间的关联。
100例患者中，97例完成随访，52例（53.6%）在停用抗心律失常药物后维持窦性心律。PD负荷和PD分布均不能预测无心律失常（风险比[HR]：1.01，95%置信区间[CI]：0.99 - 1.03，p = 0.164；HR：1.04，95%CI：0.91 - 1.17，p = 0.591）。此外，旋转性PD的负荷、旋转稳定性以及肺静脉和后壁处出现的PD负荷均不能预测心律失常复发（所有p > 0.10）。
使用ECGI标测确定的房颤机制不能预测持续性房颤PVI术后的结局。有必要采用不同方法进一步研究以表征房颤机制（NCT03394404）。
