随机试验高 vs 标准功率射频消融肺静脉隔离：SHORT-AF。
A Randomized Trial of High vs Standard Power Radiofrequency Ablation for Pulmonary Vein Isolation: SHORT-AF.
机构信息
Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA; Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
出版信息
JACC Clin Electrophysiol. 2023 Jul;9(7 Pt 2):1038-1047. doi: 10.1016/j.jacep.2022.12.020. Epub 2023 Feb 22.
BACKGROUND
High-power, short duration (HPSD) radiofrequency ablation (RFA) is a commonly used strategy for pulmonary vein isolation (PVI).
OBJECTIVES
This study sought to compare HPSD with standard power, standard duration (SPSD) RFA in patients undergoing PVI.
METHODS
Patients with paroxysmal or persistent (<1 year) atrial fibrillation (AF) were randomized to HPSD (50 W) or SPSD (25-30 W) RFA to achieve PVI. Outcomes assessed included time to achieve PVI (primary), left atrial dwell time, total procedure time, first-pass isolation, PV reconnection with adenosine, procedure complications including asymptomatic cerebral emboli (ACE), and freedom from atrial arrhythmias.
RESULTS
Sixty patients (median age 66 years; 75% male) with paroxysmal (57%) or persistent (43%) AF were randomized to HPSD (n = 29) or SPSD (n = 31). Median time to achieve PVI was shorter with HPSD vs SPSD (87 minutes vs 126 minutes; P = 0.003), as was left atrial dwell time (157 minutes vs 180 minutes; P = 0.04). There were no differences in first-pass isolation (79% vs 76%; P = 0.65) or PV reconnection with adenosine (12% vs 20%; P = 0.26) between groups. At 12 months, recurrent atrial arrhythmias occurred less in the HPSD group compared with the SPSD group (n = 3 of 29 [10%] vs n = 11 of 31 [35%]; HR: 0.26; P = 0.027). There was a trend toward more ACE with HPSD RFA (40% HPSD vs 17% SPSD; P = 0.053).
CONCLUSIONS
In patients undergoing AF ablation, HPSD compared with SPSD RFA results in shorter time to achieve PVI, greater freedom from AF at 12 months, and a trend toward increased ACE.
背景
高功率、短时间（HPSD）射频消融（RFA）是肺静脉隔离（PVI）的常用策略。
目的
本研究旨在比较 HPSD 与标准功率、标准时间（SPSD）RFA 在接受 PVI 的患者中的疗效。
方法
阵发性或持续性（<1 年）心房颤动（AF）患者被随机分为 HPSD（50 W）或 SPSD（25-30 W）RFA 组以实现 PVI。评估的结果包括达到 PVI 的时间（主要终点）、左心房停留时间、总手术时间、单次隔离、腺苷后 PV 再连接、手术并发症包括无症状性脑栓塞（ACE）以及无房性心律失常。
结果
60 例（中位年龄 66 岁；75%为男性）阵发性（57%）或持续性（43%）AF 患者被随机分为 HPSD（n=29）或 SPSD（n=31）组。与 SPSD 相比，HPSD 组达到 PVI 的时间更短（87 分钟 vs 126 分钟；P=0.003），左心房停留时间也更短（157 分钟 vs 180 分钟；P=0.04）。两组间单次隔离（79% vs 76%；P=0.65）或腺苷后 PV 再连接（12% vs 20%；P=0.26）无差异。12 个月时，与 SPSD 组相比，HPSD 组复发性房性心律失常发生率较低（n=29 例中有 3 例[10%] vs n=31 例中有 11 例[35%]；HR：0.26；P=0.027）。HPSD RFA 时 ACE 发生率有增加趋势（HPSD 组为 40%，SPSD 组为 17%；P=0.053）。
结论
在接受 AF 消融的患者中，与 SPSD RFA 相比，HPSD RFA 可缩短达到 PVI 的时间，12 个月时 AF 无复发率更高，ACE 发生率有增加趋势。
Zotero 插件