Dhillon Gurpreet, Honarbakhsh Shohreh, Abbas Hakam, Waddingham Peter, Dennis Adam S, Ahluwalia Nikhil, Finlay Malcolm, Sohaib Afzal, Welch Sophie, Daw Holly, Sporton Simon, Chow Anthony, Earley Mark J, Lambiase Pier D, Hunter Ross J
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
Heart Rhythm O2. 2023 Aug 31;4(10):609-617. doi: 10.1016/j.hroo.2023.08.004. eCollection 2023 Oct.
Mechanisms sustaining persistent atrial fibrillation (AF) remain unclear.
The study sought to evaluate both the clinical outcomes and response to ablation of potential drivers in patients with recurrent persistent AF recurrence following pulmonary vein isolation (PVI).
A total of 100 patients with persistent AF of <2 years' duration underwent cryoballoon PVI (ECGI phenotyping of persistent AF based on driver burden and distribution to predict response to pulmonary vein isolation). Patients with documented recurrence of atrial arrhythmia within 12 months were recruited and underwent repeat PVI (if needed) followed by ablation of potential drivers (PDs) identified by electrocardiographic imaging (ECGI). PDs were defined as rotational activity >1.5 revolutions or focal activations. Cycle lengths were measured pre- and postablation. The primary outcome was freedom from atrial arrhythmia off antiarrhythmic drugs at 1 year as per guidelines.
Of 37 patients recruited, 26 had recurrent AF and underwent ECGI-guided ablation of PDs. An average of 6.4 ± 2.7 PDs were targeted per patient. The mean ablation time targeting PDs was 15.5 ± 6.9 minutes. An ablation response occurred in 20 patients (AF termination in 6, cycle length prolongation ≥10% in 14). At 1 year, 14 (54%) of 26 patients were free from arrhythmia, and 12 (46%) of 26 were off antiarrhythmic drugs. Considering the 96 patients who completed follow-up out of the original cohort of 100 patients undergoing cryoablation in this staged strategy, freedom from arrhythmia at 1 year following the last procedure was 72 (75%) of 96, or 70 (73%) of 96 off antiarrhythmic drugs.
In patients with recurrent AF despite PVI, ECGI-guided ablation caused an acute response in a majority with reasonable long-term outcomes.
维持持续性心房颤动（AF）的机制仍不清楚。
本研究旨在评估肺静脉隔离（PVI）后复发性持续性AF复发患者的临床结局以及对潜在驱动因素消融的反应。
共有100例病程小于2年的持续性AF患者接受了冷冻球囊PVI（基于驱动因素负荷和分布对持续性AF进行心电图表型分析以预测对肺静脉隔离的反应）。记录到12个月内心房心律失常复发的患者被纳入研究，并接受重复PVI（如有需要），随后对通过心电图成像（ECGI）确定的潜在驱动因素（PDs）进行消融。PDs定义为旋转活动>1.5转或局灶性激动。在消融前后测量心动周期长度。主要结局是根据指南在1年时停用抗心律失常药物后无房性心律失常。
在纳入的37例患者中，26例有AF复发并接受了ECGI引导下的PDs消融。每位患者平均靶向6.4±2.7个PDs。靶向PDs的平均消融时间为15.5±6.9分钟。20例患者出现消融反应（6例AF终止，14例心动周期长度延长≥10%）。1年时，26例患者中有14例（54%）无心律失常，26例中有12例（46%）停用抗心律失常药物。在采用这种分阶段策略进行冷冻消融的最初100例患者队列中，考虑到96例完成随访的患者，最后一次手术后1年无心律失常的比例为96例中的72例（75%），或停用抗心律失常药物的比例为96例中的70例（73%）。
在尽管进行了PVI但仍有AF复发的患者中，ECGI引导下的消融在大多数患者中引起了急性反应，并取得了合理的长期结局。
