Montserrat Sílvia, Gabrielli Luigi, Borràs Roger, Cascos Enric, Castellá Manel, Sanchis Laura, Bijnens Bart, Mont Lluís, Sitges Marta
Hospital Clínic, IDIBAPS, Institut Clinic Cardiovascular (ICCV), Centro de Investigación Biomédica en Red (CIBER), Cardiovascular Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain.
Department of Cardiology, Consorci Hospitalari de Vic, Universitat Central de Catalunya, Barcelona, Spain.
Front Cardiovasc Med. 2022 Oct 31;9:928090. doi: 10.3389/fcvm.2022.928090. eCollection 2022.
The aim of this study was to compare percutaneous catheter ablation vs. minimally invasive surgical ablation, evaluating the impact of repeated ablation on atrial function, and evaluating predictors of atrial fibrillation (AF) recurrence.
When AF ablation fails, re-ablations are required in up to 40% of patients to treat recurrent arrhythmia; surgical ablation is more effective than catheter ablation.
Thirty-two patients with failed prior catheter ablation and referred for a second ablation (18 catheter and 14 surgical) were included in a descriptive observational study. Left atrial volumes, strain, and strain rate were measured with 2D speckle tracking echocardiography at baseline and 6 months after the procedures to assess left atrial functions. Patients received up to 1 year of clinical and Holter follow-up.
At the 12-month follow-up, catheter ablation was effective in 56% and surgical ablation in 72% of patients (OR 2 (CI 0.45-8.84), 0.36). Left atrial booster function was similar in all patients, but left atrial reservoir function was more impaired in those patients who underwent surgical ablation. Left atrial booster function was predictive of arrhythmia recurrence after both catheter and surgical ablation: late diastolic strain rate (LASRa) cut-off ≤ -0.89 s (sensitivity 88%, specificity 70%, AUC 0.82) and ≤ -0.85 s (sensitivity 60%, specificity 100%, AUC 0.82), respectively.
Surgical ablation has a more negative impact on LA reservoir function despite being slightly more effective in arrhythmia suppression. LA booster function is not significantly impaired by either procedure. LA booster function predicts arrhythmia elimination after a re-ablation (catheter or surgical).
本研究旨在比较经皮导管消融与微创外科消融，评估重复消融对心房功能的影响，并评估心房颤动（AF）复发的预测因素。
当AF消融失败时，高达40%的患者需要再次消融以治疗复发性心律失常；外科消融比导管消融更有效。
一项描述性观察性研究纳入了32例先前导管消融失败并转诊进行二次消融的患者（18例导管消融和14例外科消融）。在基线和手术后6个月，使用二维斑点追踪超声心动图测量左心房容积、应变和应变率，以评估左心房功能。患者接受长达1年的临床和动态心电图随访。
在12个月的随访中，导管消融对56%的患者有效，外科消融对72%的患者有效（OR 2（CI 0.45-8.84），0.36）。所有患者的左心房增强功能相似，但接受外科消融的患者左心房储存功能受损更严重。左心房增强功能可预测导管消融和外科消融后心律失常的复发：舒张晚期应变率（LASRa）截止值分别≤-0.89 s（敏感性88%，特异性70%，AUC 0.82）和≤-0.85 s（敏感性60%，特异性100%，AUC 0.82）。
尽管外科消融在抑制心律失常方面略更有效，但对左心房储存功能的负面影响更大。两种手术对左心房增强功能均无明显损害。左心房增强功能可预测再次消融（导管或外科）后心律失常的消除。
