电解剖标测引导下上腔静脉隔离术在无诱发上腔静脉触发因素的阵发性心房颤动患者中的作用：一项随机对照研究。

Role of electroanatomical mapping-guided superior vena cava isolation in paroxysmal atrial fibrillation patients without provoked superior vena cava triggers: a randomized controlled study.

机构信息

Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China.

Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.

出版信息

Europace. 2024 Mar 1;26(3). doi: 10.1093/europace/euae039.

AIMS

Data about whether empirical superior vena cava (SVC) isolation (SVCI) improves the success rate of paroxysmal atrial fibrillation (PAF) are conflicting. This study sought to first investigate the characteristics of SVC-triggered atrial fibrillation and secondly investigate the impact of electroanatomical mapping-guided SVCI, in addition to circumferential pulmonary vein isolation (CPVI), on the outcome of PAF ablation in the absence of provoked SVC triggers.

METHODS AND RESULTS

A total of 130 patients undergoing PAF ablation underwent electrophysiological studies before ablation. In patients for whom SVC triggers were identified, SVCI was performed in addition to CPVI. Patients without provoked SVC triggers were randomized in a 1:1 ratio to CPVI plus SVCI or CPVI only. The primary endpoint was freedom from any documented atrial tachyarrhythmias lasting over 30 s after a 3-month blanking period without anti-arrhythmic drugs at 12 months after ablation. Superior vena cava triggers were identified in 30 (23.1%) patients with PAF. At 12 months, 93.3% of those with provoked SVC triggers who underwent CPVI plus SVCI were free from atrial tachyarrhythmias. In patients without provoked SVC triggers, SVCI, in addition to CPVI, did not increase freedom from atrial tachyarrhythmias (87.9 vs. 79.6%, log-rank P = 0.28).

CONCLUSION

Electroanatomical mapping-guided SVCI, in addition to CPVI, did not increase the success rate of PAF ablation in patients who had no identifiable SVC triggers.

REGISTRATION

ChineseClinicalTrials.gov: ChiCTR2000034532.

目的

关于经验性上腔静脉（SVC）隔离（SVCI）是否能提高阵发性心房颤动（PAF）成功率的数据存在争议。本研究旨在首先调查 SVC 触发的心房颤动的特征，其次调查电解剖标测引导的 SVCI 除环形肺静脉隔离（CPVI）以外，对无诱发 SVC 触发的 PAF 消融结果的影响。

方法和结果

共有 130 名接受 PAF 消融的患者在消融前进行了电生理研究。在发现 SVC 触发的患者中，除 CPVI 外还进行 SVCI。无诱发 SVC 触发的患者以 1:1 的比例随机分为 CPVI 加 SVCI 或 CPVI 组。主要终点是在消融后 3 个月无抗心律失常药物的空白期后，12 个月时无任何记录的持续超过 30s 的房性心动过速/心房颤动。30 例（23.1%）PAF 患者存在 SVC 触发。在 12 个月时，CPVI 加 SVCI 治疗的 SVC 触发患者中，93.3%无房性心动过速/心房颤动。在无诱发 SVC 触发的患者中，CPVI 加 SVCI 并不能增加无房性心动过速/心房颤动的比例（87.9% vs. 79.6%，log-rank P = 0.28）。