Darden Douglas, Aldaas Omar, Du Chengan, Munir Muhammad Bilal, Feld Gregory K, Pothineni Naga Venkata K, Gopinathannair Rakesh, Lakkireddy Dhanunjaya, Curtis Jeptha P, Freeman James V, Akar Joseph G, Hsu Jonathan C
Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, USA.
Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA 92037, USA.
Europace. 2023 May 19;25(5). doi: 10.1093/europace/euad124.
No prior study has been adequately powered to evaluate real-world safety outcomes in those receiving adjunctive ablation lesions beyond pulmonary vein isolation (PVI). We sought to evaluate characteristics and in-hospital complications among patients undergoing PVI with and without adjunctive lesions.
Patients in the National Cardiovascular Data Registry AFib Ablation Registry undergoing first-time atrial fibrillation (AF) ablation between 2016 and 2020 were identified and stratified into paroxysmal (PAF) and persistent AF, and separated into PVI only, PVI + cavotricuspid isthmus (CTI) ablation, and PVI + adjunctive (superior vena cava isolation, coronary sinus, vein of Marshall, atypical atrial flutter lines, other). Adjusted odds of adverse events were calculated using multivariable logistic regression. A total of 50 937 patients [PAF: 30 551 (60%), persistent AF: 20 386 (40%)] were included. Among those with PAF, there were no differences in the adjusted odds of complications between PVI + CTI or PVI + adjunctive when compared with PVI only. Among persistent AF, PVI + adjunctive was associated with a higher risk of any complication [3.0 vs. 4.5%, odds ratio (OR) 1.30, 95% confidence interval (CI) 1.07-1.58] and major complication (0.8 vs. 1.4%, OR 1.56, 95% CI 1.10-2.21), while no differences were observed in PVI + CTI compared with PVI only. Overall, there was high heterogeneity in adjunctive lesion type, and those receiving adjunctive lesions had a higher comorbidity burden.
Additional CTI ablation was common without an increased risk of complications. Adjunctive lesions other than CTI are commonly performed in those with more comorbidities and were associated with an increased risk of complications in persistent AF, although the current analysis is limited by high heterogeneity in adjunctive lesion set type.
既往尚无充分有力的研究来评估接受肺静脉隔离（PVI）以外辅助消融灶治疗的患者的真实世界安全性结局。我们试图评估接受PVI治疗且有或无辅助消融灶的患者的特征及住院期间并发症情况。
确定了2016年至2020年间在国家心血管数据注册中心房颤消融注册研究中接受首次心房颤动（AF）消融的患者，并将其分为阵发性（PAF）和持续性AF，再分为单纯PVI组、PVI + 三尖瓣峡部（CTI）消融组以及PVI + 辅助消融组（上腔静脉隔离、冠状窦、Marshall静脉、非典型房扑消融线、其他）。使用多变量逻辑回归计算不良事件的校正比值比。共纳入50937例患者[PAF：30551例（60%），持续性AF：20386例（40%）]。在PAF患者中，与单纯PVI组相比，PVI + CTI组或PVI + 辅助消融组并发症的校正比值比无差异。在持续性AF患者中，PVI + 辅助消融组发生任何并发症的风险更高[3.0%对4.5%，比值比（OR）1.30，95%置信区间（CI）1.07 - 1.58]以及发生主要并发症的风险更高（0.8%对1.4%，OR 1.56，95% CI 1.10 - 2.21），而与单纯PVI组相比，PVI + CTI组未观察到差异。总体而言，辅助消融灶类型存在高度异质性，接受辅助消融灶治疗的患者合并症负担更高。
额外的CTI消融很常见，且并发症风险未增加。除CTI外的辅助消融在合并症更多的患者中普遍进行，并且与持续性AF患者并发症风险增加相关，尽管目前的分析受辅助消融灶类型高度异质性的限制。
