Andrade Jason G, Deyell Marc W, Khairy Paul, Champagne Jean, Leong-Sit Peter, Novak Paul, Sterns Lawrence, Roux Jean-Francois, Sapp John, Bennett Richard, Bennett Matthew, Hawkins Nathaniel, Sanders Prashanthan, Macle Laurent
Department of Medicine, University of British Columbia, 2775 Laurel St 10th Floor, Vancouver, BC V5Z 1M9, Canada.
Center for Cardiovascular Innovation, 2775 Laurel St 9th Floor, Vancouver, BC V5Z 1M9, Canada.
Eur Heart J. 2024 Feb 16;45(7):510-518. doi: 10.1093/eurheartj/ehad572.
Atrial fibrillation (AF) is a chronic progressive disorder. Persistent forms of AF are associated with increased rates of thromboembolism, heart failure, and death. Catheter ablation modifies the pathogenic mechanism of AF progression. No randomized studies have evaluated the impact of the ablation energy on progression to persistent atrial tachyarrhythmia.
Three hundred forty-six patients with drug-refractory paroxysmal AF were enrolled and randomly assigned to contact-force-guided RF ablation (CF-RF ablation, 115), 4 min cryoballoon ablation (CRYO-4, 115), or 2 min cryoballoon ablation (CRYO-2, 116). Implantable cardiac monitors placed at study entry were used for follow-up. The main outcome was the first episode of persistent atrial tachyarrhythmia. Secondary outcomes included atrial tachyarrhythmia recurrence and arrhythmia burden on the implantable monitor.
At a median of 944.0 (interquartile range [IQR], 612.5-1104) days, 0 of 115 patients (0.0%) randomly assigned to CF-RF, 8 of 115 patients (7.0%) assigned to CRYO-4, and 5 of 116 patients (4.3%) assigned to CRYO-2 experienced an episode of persistent atrial tachyarrhythmia (P = .03). A documented recurrence of any atrial tachyarrhythmia ≥30 s occurred in 56.5%, 53.9%, and 62.9% of those randomized to CF-RF, CRYO-4, and CRYO-2, respectively; P = .65. Compared with that of the pre-ablation monitoring period, AF burden was reduced by a median of 99.5% (IQR 94.0%, 100.0%) with CF-RF, 99.9% (IQR 93.3%-100.0%) with CRYO-4, and 99.1%% (IQR 87.0%-100.0%) with CRYO-2 (P = .38).
Catheter ablation of paroxysmal AF using radiofrequency energy was associated with fewer patients developing persistent AF on follow-up.
心房颤动（AF）是一种慢性进行性疾病。持续性AF与血栓栓塞、心力衰竭和死亡发生率增加相关。导管消融可改变AF进展的致病机制。尚无随机研究评估消融能量对进展为持续性房性快速性心律失常的影响。
纳入346例药物难治性阵发性AF患者，随机分配至接触力引导下射频消融组（CF-RF消融，115例）、4分钟冷冻球囊消融组（CRYO-4，115例）或2分钟冷冻球囊消融组（CRYO-2，116例）。研究开始时植入的心脏监测器用于随访。主要结局是首次发生持续性房性快速性心律失常。次要结局包括房性快速性心律失常复发以及植入式监测器上的心律失常负荷。
在中位数为944.0（四分位间距[IQR]，612.5 - 1104）天的随访中，随机分配至CF-RF组的115例患者中有0例（0.0%）、CRYO-4组的115例患者中有8例（7.0%）、CRYO-2组的116例患者中有5例（4.3%）发生持续性房性快速性心律失常（P = 0.03）。随机分配至CF-RF、CRYO-4和CRYO-2组的患者中，记录到任何房性快速性心律失常复发≥30秒的比例分别为56.5%、53.9%和62.9%；P = 0.65。与消融前监测期相比，CF-RF组的AF负荷中位数降低了99.5%（IQR 94.0%，100.0%），CRYO-4组降低了99.9%（IQR 93.3% - 100.0%），CRYO-2组降低了99.1%（IQR 87.0% - 100.0%）（P = 0.38）。
使用射频能量进行阵发性AF的导管消融与随访中发生持续性AF的患者较少相关。
