Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium.
Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium.
JACC Clin Electrophysiol. 2023 Oct;9(10):2071-2081. doi: 10.1016/j.jacep.2023.06.004. Epub 2023 Aug 2.
Persistent shock-resistant atrial fibrillation (AF) is a challenging entity, with modest results from catheter ablation according to conventional survival analysis.
The aim of this study was to determine the effect of catheter ablation on atrial tachyarrhythmia (ATA) burden in persistent AF patients undergoing first-time ablation with the use of an implantable cardiac monitor (ICM).
Patients with drug-resistant ongoing persistent AF and at least 1 previous failed cardioversion were implanted with an ICM 2 months before the procedure. All patients underwent pulmonary vein isolation with or without additional substrate ablation depending on the presence of self-terminating AF on ICM and left atrium size. Median AF burden before and after ablation, off antiarrhythmic medication, was determined from ICM recordings after review by 2 independent investigators.
Sixty patients were recruited (mean age 66 ± 9 years, 70% male). Mean left atrial diameter was 48 ± 6 mm and median CHADSVASc score was 2. Ten patients (17%) unexpectedly demonstrated self-terminating AF before ablation. The median burden of ATA before ablation was 100% (95% CI: 19.6%-100%), decreasing to 0% (95% CI: 0%-95.8%) after ablation during the post-blanking follow-up period (median reduction 100%; 95% CI: 4%-100%; P < 0.001). Twenty-seven patients (45%) experienced recurrent ATA during 12-month follow-up. In these patients, median burden before ablation was 100% (95% CI: 26.9%-100%), decreasing to 11.4% (95% CI: 0.35%-99.7%) after ablation (P < 0.001). Quality of life improved significantly from baseline, driven by lack of recurrence.
Patient-tailored catheter ablation results in a significant reduction in ATA burden (off antiarrhythmic medication) in shock-resistant persistent AF patients using ICMs implanted 2-months pre-procedure. These data suggest that conventional arrhythmia-free survival analysis does not capture the true impact of catheter ablation in this challenging cohort.
持续性抗休克性心房颤动（AF）是一种具有挑战性的病症，根据传统的生存分析，导管消融的效果并不理想。
本研究旨在通过植入式心脏监测仪（ICM）确定导管消融对持续性 AF 患者首次消融后房性心动过速（ATA）负担的影响。
将至少有 1 次电复律失败且正在服用药物的持续性 AF 患者，在手术前 2 个月植入 ICM。所有患者均接受肺静脉隔离术，是否进行基质消融取决于 ICM 上自我终止性 AF 的存在和左心房大小。由 2 名独立的研究者对 ICM 记录进行审查后，确定消融前后、停止使用抗心律失常药物时的 AF 负担中位数。
共纳入 60 例患者（平均年龄 66 ± 9 岁，70%为男性）。平均左心房直径为 48 ± 6mm，中位 CHADSVASc 评分为 2。10 例（17%）患者在消融前出现意外的自我终止性 AF。消融前 ATA 的中位负担为 100%（95%CI：19.6%-100%），在消融后空白期（中位减少 100%；95%CI：4%-100%；P<0.001）降至 0%（95%CI：0%-95.8%）。在 12 个月的随访中，27 例（45%）患者出现复发性 ATA。在这些患者中，消融前中位负担为 100%（95%CI：26.9%-100%），降至 11.4%（95%CI：0.35%-99.7%）（P<0.001）。生活质量显著改善，原因是无复发。
使用植入式心脏监测仪（ICM）的患者进行个体化的导管消融，可显著降低抗休克性持续性 AF 患者的 ATA 负担（停止使用抗心律失常药物）。这些数据表明，传统的无心律失常生存分析并未捕捉到导管消融在这一具有挑战性的患者群体中的真正影响。
