Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
R&D Algorithms, Acutus Medical, Carlsbad, CA, USA.
Europace. 2023 May 19;25(5). doi: 10.1093/europace/euad097.
RECOVER AF evaluated the performance of whole-chamber non-contact charge-density mapping to guide the ablation of non-pulmonary vein (PV) targets in persistent atrial fibrillation (AF) patients following either a first or second failed procedure.
RECOVER AF was a prospective, non-randomized trial that enrolled patients scheduled for a first or second ablation retreatment for recurrent AF. The PVs were assessed and re-isolated if necessary. The AF maps were used to guide the ablation of non-PV targets through elimination of pathologic conduction patterns (PCPs). Primary endpoint was freedom from AF on or off antiarrhythmic drugs (AADs) at 12 months. Patients undergoing retreatment with the AcQMap System (n = 103) were 76% AF-free at 12 months [67% after single procedure (SP)] on or off AADs (80% free from AF on AADs). Patients who had only received a pulmonary vein isolation (PVI) prior to study treatment of non-PV targets with the AcQMap System were 91% AF-free at 12 months (83% SP). No major adverse events were reported.
Non-contact mapping can be used to target and guide the ablation of PCPs beyond the PVs in persistent AF patients returning for a first or second retreatment with 76% freedom from AF at 12 months. The AF freedom was particularly high, 91% (43/47), for patients enrolled having only a prior de novo PVI, and freedom from all atrial arrhythmias for this cohort was 74% (35/47). These early results are encouraging and suggest that guiding individualized targeted ablation of PCPs may therefore be advantageous to target at the earliest opportunity in patients with persistent AF.
RECOVER AF 评估了整体非接触电荷密度标测引导持续性心房颤动（AF）患者首次或第二次失败后消融非肺静脉（PV）靶点的性能。
RECOVER AF 是一项前瞻性、非随机试验，纳入了计划首次或第二次消融复发性 AF 的患者。评估 PV 并在必要时重新隔离。使用 AF 图通过消除病理性传导模式（PCPs）来引导非 PV 靶点的消融。主要终点是在 12 个月时停用或不停用抗心律失常药物（AAD）时 AF 消除。使用 AcQMap 系统进行再次治疗的患者（n = 103）在 12 个月时停用或不停用 AAD 时，76%无 AF（SP 后 67%）（80%在 AAD 上无 AF）。在研究治疗之前仅接受过肺静脉隔离（PVI）的患者，在 12 个月时 91%无 AF（83%SP）。未报告重大不良事件。
非接触式标测可用于定位和引导持续性 AF 患者的 PCP 消融，这些患者在首次或第二次复治时使用 AcQMap 系统治疗非 PV 靶点，12 个月时的 AF 消除率为 76%。对于仅接受过首次 PVI 的患者，AF 消除率特别高，为 91%（43/47），对于这一组患者，所有房性心律失常的消除率为 74%（35/47）。这些早期结果令人鼓舞，表明在持续性 AF 患者中，尽早引导个体化靶向消融 PCP 可能是有利的。
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