Havranek Stepan, Fingrova Zdenka, Skala Tomas, Reichenbach Adrian, Dusik Milan, Jansa Pavel, Ambroz David, Dytrych Vladimir, Klimes Dalibor, Hutyra Martin, Kautzner Josef, Linhart Ales, Wichterle Dan
2nd Department of Medicine-Department of Cardiovascular Medicine of the 1st Faculty of Medicine and General University Hospital in Prague, U Nemocnice 2, 12800 Prague, Czech Republic.
First Department of Internal Medicine-Cardiology, Olomouc University Hospital, Olomouc, Czech Republic.
Europace. 2023 May 19;25(5). doi: 10.1093/europace/euad131.
Atrial fibrillation (AF), typical atrial flutter (AFL), and other atrial tachycardias (ATs) are common in patients with pulmonary hypertension. Frequently, several supraventricular arrhythmias are successively observed in individual patients. We investigated the hypothesis of whether more extensive radiofrequency catheter ablation of the bi-atrial arrhythmogenic substrate instead of clinical arrhythmia ablation alone results in superior clinical outcomes in patients with pulmonary arterial hypertension (PH) and supraventricular arrhythmias.
Patients with combined post- and pre-capillary or isolated pre-capillary PH and supraventricular arrhythmia indicated to catheter ablation were enrolled in three centres and randomized 1:1 into two parallel treatment arms. Patients underwent either clinical arrhythmia ablation only (Limited ablation group) or clinical arrhythmia plus substrate-based ablation (Extended ablation group). The primary endpoint was arrhythmia recurrence >30 s without antiarrhythmic drugs after the 3-month blanking period. A total of 77 patients (mean age 67 ± 10 years; 41 males) were enrolled. The presumable clinical arrhythmia was AF in 38 and AT in 36 patients, including typical AFL in 23 patients. During the median follow-up period of 13 (interquartile range: 12; 19) months, the primary endpoint occurred in 15 patients (42%) vs. 17 patients (45%) in the Extended vs. Limited ablation group (hazard ratio: 0.97, 95% confidence interval: 0.49-2.0). There was no excess of procedural complications and clinical follow-up events including an all-cause death in the Extended ablation group.
Extensive ablation, compared with a limited approach, was not beneficial in terms of arrhythmia recurrence in patients with AF/AT and PH.
ClinicalTrials.gov; NCT04053361.
心房颤动（AF）、典型心房扑动（AFL）和其他房性心动过速（ATs）在肺动脉高压患者中很常见。通常，在个体患者中会相继观察到几种室上性心律失常。我们研究了以下假设：对于肺动脉高压（PH）和室上性心律失常患者，相较于仅进行临床心律失常消融，更广泛地对双房致心律失常基质进行射频导管消融是否能带来更好的临床结果。
合并毛细血管后和毛细血管前或单纯毛细血管前PH以及因室上性心律失常而需进行导管消融的患者在三个中心入组，并按1:1随机分为两个平行治疗组。患者要么仅接受临床心律失常消融（有限消融组），要么接受临床心律失常消融加基于基质的消融（扩展消融组）。主要终点是在3个月的空白期后，无抗心律失常药物情况下心律失常复发>30秒。共纳入77例患者（平均年龄67±10岁；41例男性）。推测的临床心律失常在38例患者中为AF，36例患者中为AT，其中23例患者为典型AFL。在中位随访期13（四分位间距：12；19）个月期间，扩展消融组有15例患者（42%）达到主要终点，有限消融组有17例患者（45%）达到主要终点（风险比：0.97，95%置信区间：0.49 - 2.0）。扩展消融组在手术并发症和临床随访事件（包括全因死亡）方面没有增加。
与有限消融方法相比，广泛消融在AF/AT和PH患者的心律失常复发方面并无益处。
ClinicalTrials.gov；NCT04053361。
