Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK.
J Interv Card Electrophysiol. 2024 Aug;67(5):1181-1189. doi: 10.1007/s10840-024-01750-w. Epub 2024 Jan 23.
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Despite promising success rates, redo ablation is sometimes required. At redo, PVs may be found to be isolated (silent) or reconnected. We studied patients with silent vs reconnected PVs at redo and analysed associations with adverse outcomes.
Patients undergoing redo AF ablations between 2013 and 2019 at our institution were included and stratified into silent PVs or reconnected PVs. The primary outcome was a composite of further redo ablation, non-AF ablation, atrioventricular nodal ablation, and death. Secondary outcomes included arrhythmia recurrence.
A total of 467 patients were included with mean 4.6 ± 1.7 years follow-up, of whom 48 (10.3%) had silent PVs. The silent PV group had had more often undergone >1 prior ablation (45.8% vs 9.8%; p<0.001), had more persistent AF (62.5% vs 41.1%; p=0.005) and had more non-PV ablation performed both at prior ablation procedures and at the analysed redo ablation. The primary outcome occurred more frequently in those with silent PVs (25% vs 13.8%; p=0.053). Arrhythmia recurrence was also more common in the silent PV group (66.7% vs 50.6%; p=0.047). After multivariable adjustment, female sex (aHR 2.35 [95% CI 2.35-3.96]; p=0.001) and ischaemic heart disease (aHR 3.21 [95% CI 1.56-6.62]; p=0.002) were independently associated with the primary outcome, and left atrial enlargement (aHR 1.58 [95% CI 1.20-2.08]; p=0.001) and >1 prior ablation (aHR 1.88 [95% CI 1.30-2.72]; p<0.001) were independently associated with arrhythmia recurrence. Whilst a finding of silent PVs was not itself significant after multivariable adjustment, this provides an easily assessable parameter at clinically indicated redo ablation which informs the clinician of the likelihood of a worse future prognosis.
Patients with silent PVs at redo AF ablation have worse clinical outcomes.
肺静脉隔离（PVI）是房颤（AF）消融的基石。尽管成功率较高，但有时仍需要进行再次消融。在再次消融时，可能会发现肺静脉呈隔离（沉默）或重新连接。我们研究了在再次消融时发现沉默或重新连接的肺静脉的患者，并分析了与不良结局的关联。
纳入 2013 年至 2019 年在我院行再次 AF 消融的患者，并分为沉默肺静脉或重新连接的肺静脉。主要结局是进一步再次消融、非 AF 消融、房室结消融和死亡的复合结局。次要结局包括心律失常复发。
共纳入 467 例患者，平均随访 4.6±1.7 年，其中 48 例（10.3%）存在沉默肺静脉。沉默肺静脉组既往消融次数较多（45.8%比 9.8%；p<0.001），持续性房颤较多（62.5%比 41.1%；p=0.005），且在之前的消融手术和分析的再次消融中进行了更多的非肺静脉消融。沉默肺静脉组主要结局发生率更高（25%比 13.8%；p=0.053）。沉默肺静脉组心律失常复发也更为常见（66.7%比 50.6%；p=0.047）。多变量调整后，女性（aHR 2.35[95%CI 2.35-3.96]；p=0.001）和缺血性心脏病（aHR 3.21[95%CI 1.56-6.62]；p=0.002）与主要结局独立相关，左心房扩大（aHR 1.58[95%CI 1.20-2.08]；p=0.001）和>1 次消融（aHR 1.88[95%CI 1.30-2.72]；p<0.001）与心律失常复发独立相关。尽管多变量调整后沉默肺静脉的发现本身并不显著，但这提供了一个在临床指征下再次消融时易于评估的参数，为临床医生提供了未来预后较差的可能性。
在房颤消融的再次消融中发现沉默肺静脉的患者临床结局较差。
