Taghji Philippe, Deharo Jean-Claude, Amraoui Sana, Bun Sok-Sithikun
Electrophysiology Unit, Cardiology Department, La Timone University Hospital, 13005 Marseille, France.
Electrophysiology Unit, Cardiology Department, American Hospital of Paris, 92200 Neuilly-sur-Seine, France.
J Clin Med. 2023 Jul 15;12(14):4698. doi: 10.3390/jcm12144698.
CLOSE-guided pulmonary vein isolation (PVI) is based on contiguous and optimized (Ablation Index-guided) radiofrequency lesions. The efficacy of CLOSE-guided PVI in persistent atrial fibrillation (AF) treatment has been poorly evaluated.
In two centers, 50 patients eligible for persistent AF ablation underwent CLOSE-guided PVI (Ablation Index ≥ 450 at the anterior wall, ≥300 at posterior wall, intertag distance ≤ 6 mm). If PVI failed to restore sinus rhythm (SR), electrical cardioversion (ECV) was performed. Atrial substrate modification (ASM) was performed only if PVI and ECV failed to restore SR. Recurrence was defined as any recorded episode of AF, atrial tachycardia (AT) or atrial flutter (AFL) > 30 s on Holter electrocardiographs at 3, 6 and 12 months.
From the 50 patients (64 ± 10 years, 14% long-standing persistent AF), SR was restored by ECV in 34 patients (68%) 56 ± 38 days prior to ablation. On the day of ablation, 42 patients (84%) were on class I-III anti-arrhythmic drug therapy (ADT) and the rhythm was AF in 23/50 patients. PVI was achieved in all patients; after PVI, ECV was required in 21 patients and ASM in 1 patient. The mean procedure time, radiofrequency time and fluoroscopy time were 141 ± 33 min, 23 ± 7 min and 7 ± 6 min, respectively. At 12 months, single-procedure freedom from AF/AT/AFL was 80%, with 19 patients (38%) receiving class I-III ADT.
In a population of patients with persistent AF monitored with intermittent cardiac rhythm recordings, CLOSE-guided PVI resulted in high single-procedure arrhythmia-free survival at 1 year. Future large-scale studies involving continuous cardiac monitoring are necessary.
CLOSE引导下的肺静脉隔离术（PVI）基于连续且优化（消融指数引导）的射频消融损伤。CLOSE引导下的PVI治疗持续性心房颤动（AF）的疗效评估不足。
在两个中心，50例符合持续性AF消融条件的患者接受了CLOSE引导下的PVI（前壁消融指数≥450，后壁≥300，相邻标记点距离≤6mm）。如果PVI未能恢复窦性心律（SR），则进行电复律（ECV）。仅当PVI和ECV均未能恢复SR时才进行心房基质改良（ASM）。复发定义为在3、6和12个月时动态心电图记录到任何持续时间>30秒的AF、房性心动过速（AT）或心房扑动（AFL）发作。
50例患者（64±10岁，14%为长期持续性AF）中，34例患者（68%）在消融前56±38天通过ECV恢复了SR。在消融当天，42例患者（84%）正在接受I-III类抗心律失常药物治疗（ADT），23/50例患者的心律为AF。所有患者均成功完成PVI；PVI后，21例患者需要ECV，1例患者需要ASM。平均手术时间、射频时间和透视时间分别为141±33分钟、23±7分钟和7±6分钟。在12个月时，单次手术无AF/AT/AFL的生存率为80%，19例患者（38%）接受I-III类ADT。
在通过间歇性心律记录监测的持续性AF患者群体中，CLOSE引导下的PVI在1年时实现了较高的单次手术无心律失常生存率。未来有必要开展涉及连续心脏监测的大规模研究。
