Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 West Huaihai Road, Shanghai 200030, China.
Department of Clinical Integration of Traditional Chinese and Western medicine, First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China.
Europace. 2023 May 19;25(5). doi: 10.1093/europace/euad090.
The optimal strategy for persistent atrial fibrillation (PerAF) is poorly defined. We conducted a multicentre, randomized, prospective trial to compare the outcomes of different ablation strategies for PerAF.
We enrolled 450 patients and randomly assigned them in a 1:1:1 ratio to undergo pulmonary vein isolation and subsequently undergo the following three different ablation strategies: anatomical guided ablation (ANAT group, n = 150), electrogram guided ablation (EGM group, n = 150), and extensive electro-anatomical guided ablation (EXT group, n = 150). The primary endpoint was freedom from atrial fibrillation (AF) lasting longer than 30 s at 12 months after a single ablation procedure. After 12 months of follow-up, 72% (108) of patients in the EXT group were free from AF recurrence, as compared with the 64% (96) in the EGM group (P = 0.116), and 54% (81) in the ANAT group (P = 0.002). The EXT group showed less AF/atrial tachycardia recurrence than the EGM group (60% vs. 50%, P = 0.064) and the ANAT group (60% vs. 37.3%, P < 0.001). The EXT group showed the highest rate of AF termination (66.7%), followed by 56.7% in the EGM group, and 20.7% in the ANAT group. The AF termination signified less AF recurrence at 12 months compared to patients without AF termination (30.1% vs. 42.7%, P = 0.008). Safety endpoints did not differ significantly between the three groups (P = 0.924).
Electro-anatomical guided ablation achieved the most favourable outcomes among the three ablation strategies. The AF termination is a reliable ablation endpoint.
持续性心房颤动（PerAF）的最佳策略尚未明确。我们进行了一项多中心、随机、前瞻性试验，旨在比较不同消融策略治疗 PerAF 的效果。
我们纳入了 450 名患者，并将其以 1:1:1 的比例随机分配，分别接受肺静脉隔离，随后进行以下三种不同的消融策略：解剖引导消融（ANAT 组，n = 150）、电图引导消融（EGM 组，n = 150）和广泛电解剖引导消融（EXT 组，n = 150）。主要终点是在单次消融后 12 个月内无持续 30s 以上的心房颤动（AF）。随访 12 个月后，EXT 组有 72%（108 例）的患者无 AF 复发，而 EGM 组为 64%（96 例）（P = 0.116），ANAT 组为 54%（81 例）（P = 0.002）。与 EGM 组（60% vs. 50%，P = 0.064）和 ANAT 组（60% vs. 37.3%，P < 0.001）相比，EXT 组的 AF/房性心动过速复发更少。EXT 组的 AF 终止率最高（66.7%），其次是 EGM 组（56.7%）和 ANAT 组（20.7%）。与未终止 AF 的患者相比，AF 终止的患者在 12 个月时的 AF 复发率较低（30.1% vs. 42.7%，P = 0.008）。三组之间的安全性终点无显著差异（P = 0.924）。
在三种消融策略中，电解剖引导消融的效果最佳。AF 终止是一个可靠的消融终点。
