Department of Cardiology, Royal Melbourne Hospital, Level 2, 300 Grattan Street, Melbourne, VIC 3050, Australia.
Department of Medicine, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia.
Eur Heart J. 2023 Jul 14;44(27):2447-2454. doi: 10.1093/eurheartj/ehad247.
Catheter ablation is an effective strategy in atrial fibrillation (AF). However, its timing in the course of management remains unclear. The aim of this study was to determine if an early vs. delayed AF ablation strategy is associated with differences in arrhythmia outcomes during 12-month follow-up.
One hundred patients with symptomatic AF referred to a tertiary centre for management were randomized in a 1:1 ratio to either an early ablation strategy (within 1 month of recruitment) or a delayed ablation strategy (optimized medical therapy followed by catheter ablation at 12 months post recruitment). The primary endpoint was atrial arrhythmia free survival at 12 months post-ablation. Secondary outcomes included: (i) AF burden, (ii) AF burden by AF phenotype, and (iii) antiarrhythmic drug (AAD) use at 12 months. Overall, 89 patients completed the study protocol (Early vs. Delayed: 48 vs. 41). Mean age was 59 ± 12.9 years (29% women). Pulmonary vein isolation was achieved in 100% of patients. At 12 months, 56.3% of patients in the early ablation group were free from recurrent arrhythmia, compared with 58.6% in the delayed ablation group (HR 1.12, 95% CI 0.59-2.13, P = 0.7). All secondary outcomes showed no significant difference including median AF burden (Early vs. Delayed: 0% [IQR 3.2] vs. 0% [5], P = 0.66), median AF burden amongst paroxysmal AF patients (0% [IQR 1.1] vs. 0% [4.5], P = 0.78), or persistent AF patients (0% [IQR 22.8] vs. 0% [5.6], P = 0.45) or AAD use (33% vs. 37%, P = 0.8).
Compared with an early ablation strategy, delaying AF ablation by 12 months for AAD management did not result in reduced ablation efficacy.
导管消融是房颤（AF）的有效治疗策略。然而，其在管理过程中的时机仍不明确。本研究旨在确定早期与延迟 AF 消融策略是否与 12 个月随访期间的心律失常结局差异相关。
100 例有症状的 AF 患者被随机分为 1:1 比例的早期消融策略（招募后 1 个月内）或延迟消融策略（优化药物治疗后，招募后 12 个月行导管消融）组。主要终点为消融后 12 个月的无房性心律失常生存。次要结局包括：（i）AF 负荷，（ii）AF 负荷按 AF 表型，（iii）12 个月时抗心律失常药物（AAD）的使用。共有 89 例患者完成了研究方案（早期组 vs. 延迟组：48 例 vs. 41 例）。平均年龄为 59±12.9 岁（29%为女性）。100%的患者实现了肺静脉隔离。在 12 个月时，早期消融组 56.3%的患者无复发性心律失常，而延迟消融组为 58.6%（HR 1.12，95%CI 0.59-2.13，P=0.7）。所有次要结局均无显著差异，包括中位 AF 负荷（早期 vs. 延迟：0%[IQR 3.2] vs. 0%[5]，P=0.66）、阵发性 AF 患者的中位 AF 负荷（0%[IQR 1.1] vs. 0%[4.5]，P=0.78）、持续性 AF 患者的中位 AF 负荷（0%[IQR 22.8] vs. 0%[5.6]，P=0.45）或 AAD 使用（33% vs. 37%，P=0.8）。
与早期消融策略相比，延迟 12 个月进行 AF 消融以进行 AAD 管理并未降低消融效果。
