用于持续性心房颤动重复导管消融的偶极密度引导导管消融与传统基质改良术的比较

Dipole Density Guided Catheter Ablation versus Conventional Substrate Modification for Repeat Catheter Ablation of Persistent Atrial Fibrillation.

作者信息

Schipper Jan-Hendrik, Steven Daniel, Lüker Jakob, Wörmann Jonas, van den Bruck Jan-Hendrik, Filipovic Karlo, Dittrich Sebastian, Scheurlen Cornelia, Erlhöfer Susanne, Pavel Friederike, Sultan Arian

机构信息

Department of Electrophysiology, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.

出版信息

J Clin Med. 2023 Dec 30;13(1):223. doi: 10.3390/jcm13010223.

DOI:10.3390/jcm13010223

PMID:38202230

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10779490/

Abstract

AIMS

The optimal ablation strategy for recurrent persistent atrial fibrillation (persAF) after initially successful catheter ablation (CA) remains debatable. Dipole density (DD) guided CA using the AcQMap system has been proven to be feasible and effective in patients with persAF. So far, long-term outcome data for DD-guided CA in patients with recurrence of persAF are sparse. This study sought to assess long-term outcome data in patients undergoing a DD-guided CA for recurrence of persAF after previous CA in comparison to conventional repeat CA.

METHODS AND RESULTS

Patients undergoing DD-guided CA for recurrence of persAF after previous ablation were compared to patients undergoing conventional substrate modification (CSM). A total of 64 patients (32 DD-guided and 32 CSM) were included in this analysis. Procedure duration (DD: 236 ± 61 min; CSM: 198 ± 59 min; = 0.004) and fluoroscopy time (DD: 36 ± 15 min; CSM: 20 ± 11 min; = 0.0001) were significantly longer in the DD group. After a long-term median follow-up (FU) of 27 months (interquartile range 12.8-34.3), DD-guided CA was inferior to CSM regarding overall arrhythmia-free survival (DD: 6 patients (19%), CSM: 11 patients (34%); HR 1.47; = 0.04). Freedom from AF did not differ between both groups (DD: 16 patients (50%); CSM: 18 patients (56%), HR 0.99, = 0.47). During FU, more patients underwent repeat CA after DD-guided ablation (DD: 16 patients (50%), CSM: 7 patients (22%), = 0.04). No major complications occurred overall.

CONCLUSIONS

Dipole density-guided CA is equally safe but associated with longer procedure duration compared to conventional substrate modification for treatment of recurrent persAF after previous CA. Of note, long-term arrhythmia-free survival is significantly worse after DD-guided ablation, and more patients undergo redo procedures.

摘要

目的

对于首次导管消融（CA）成功后的复发性持续性房颤（persAF），最佳消融策略仍存在争议。使用AcQMap系统进行偶极密度（DD）引导的CA已被证明在persAF患者中是可行且有效的。到目前为止，关于DD引导的CA在persAF复发患者中的长期结局数据较少。本研究旨在评估与传统重复CA相比，接受DD引导的CA治疗persAF复发患者的长期结局数据。

方法与结果

将接受DD引导的CA治疗persAF复发的患者与接受传统基质改良（CSM）的患者进行比较。本分析共纳入64例患者（32例DD引导组和32例CSM组）。手术时间（DD组：236±61分钟；CSM组：198±59分钟；P = 0.004）和透视时间（DD组：36±15分钟；CSM组：20±11分钟；P = 0.0001）在DD组显著更长。经过27个月的长期中位随访（FU）（四分位间距12.8 - 34.3），在总体无心律失常生存率方面，DD引导的CA劣于CSM（DD组：6例患者（19%），CSM组：11例患者（34%）；HR 1.47；P = 0.04）。两组之间的无房颤率无差异（DD组：16例患者（50%）；CSM组：18例患者（56%），HR 0.99，P = 0.47）。在随访期间，DD引导消融后更多患者接受了重复CA（DD组：16例患者（50%），CSM组：7例患者（22%），P = 0.04）。总体未发生重大并发症。