Benali Karim, Barré Valentin, Hermida Alexis, Galand Vincent, Milhem Antoine, Philibert Séverine, Boveda Serge, Bars Clément, Anselme Frédéric, Maille Baptiste, André Clémentine, Behaghel Albin, Moubarak Ghassan, Clémenty Nicolas, Da Costa Antoine, Arnaud Marine, Venier Sandrine, Sebag Frédéric, Jésel-Morel Laurence, Sagnard Audrey, Champ-Rigot Laure, Dang Duc, Guy-Moyat Benoit, Abbey Selim, Garcia Rodrigue, Césari Olivier, Badenco Nicolas, Lepillier Antoine, Ninni Sandro, Boulé Stéphane, Maury Philippe, Algalarrondo Vincent, Bakouboula Babé, Mansourati Jacques, Lesaffre François, Lagrange Philippe, Bouzeman Abdeslam, Muresan Lucian, Bacquelin Raoul, Bortone Agustin, Bun Sok-Sithikun, Pavin Dominique, Macle Laurent, Martins Raphaël P
CHU Saint Etienne, University of Rennes, INSERM, LTSI -UMR 1099, Rennes (K.B.).
University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.).
Circ Arrhythm Electrophysiol. 2023 Mar;16(3):e011354. doi: 10.1161/CIRCEP.122.011354. Epub 2023 Feb 20.
Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We analyzed the impact of current ablation strategies in a large multicenter study.
Patients undergoing a redo ablation for AF and presenting durable PVI were included. The freedom from atrial arrhythmia after pulmonary vein-based, linear-based, electrogram-based, and trigger-based ablation strategies were compared.
Between 2010 and 2020, 367 patients (67% men, 63±10 years, 44% paroxysmal) underwent a redo ablation for AF recurrences despite durable PVI at 39 centers. After durable PVI was confirmed, linear-based ablation was performed in 219 (60%) patients, electrogram-based ablation in 168 (45%) patients, trigger-based ablation in 101 (27%) patients, and pulmonary vein-based ablation in 56 (15%) patients. Seven patients (2%) did not undergo any additional ablation during the redo procedure. After 22±19 months of follow-up, 122 (33%) and 159 (43%) patients had a recurrence of atrial arrhythmia at 12 and 24 months, respectively. No significant difference in arrhythmia-free survival was observed between the different ablation strategies. Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13-2.23]; =0.006).
In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population.
肺静脉隔离（PVI）术后房颤（AF）复发主要归因于肺静脉重新连接。然而，尽管PVI持久有效，但仍有越来越多的患者出现房颤复发。这些患者的最佳消融策略尚不清楚。我们在一项大型多中心研究中分析了当前消融策略的影响。
纳入因房颤复发接受再次消融且PVI持久有效的患者。比较基于肺静脉、基于线性、基于电图和基于触发点的消融策略术后无房性心律失常的情况。
2010年至2020年期间，367例患者（67%为男性，年龄63±10岁，44%为阵发性房颤）在39个中心因房颤复发接受了再次消融，尽管PVI持久有效。确认PVI持久有效后，219例（60%）患者接受了基于线性的消融，168例（45%）患者接受了基于电图的消融，101例（27%）患者接受了基于触发点的消融，56例（15%）患者接受了基于肺静脉的消融。7例患者（2%）在再次手术期间未进行任何额外消融。经过22±19个月的随访，分别有122例（33%）和159例（43%）患者在12个月和24个月时出现房性心律失常复发。不同消融策略之间在无心律失常生存期方面未观察到显著差异。左心房扩大是与无心律失常生存期相关的唯一独立因素（HR，1.59[95%CI，1.13 - 2.23]；P = 0.006）。
对于尽管PVI持久有效但仍有房颤复发的患者，在再次手术期间单独使用或联合使用的任何消融策略在改善无心律失常生存期方面似乎都不具有优势。左心房大小是该人群消融结果的重要预测指标。
