Alderete José, Fernández-Armenta Juan, Zucchelli Giulio, Sommer Philipp, Nazarian Saman, Falasconi Giulio, Soto-Iglesias David, Silva Etel, Mazzocchetti Lorenzo, Bergau Leonard, Khoshknab Mirmilad, Penela Diego, Berruezo Antonio
Arrhythmia Department, Heart Institute, Teknon Medical Centre, C/Vilana 12, 08022, Barcelona, Spain.
Campus Clinic, University of Barcelona, C/Villarroel 170, 08024, Barcelona, Spain.
J Interv Card Electrophysiol. 2024 Dec;67(9):2089-2099. doi: 10.1007/s10840-024-01871-2. Epub 2024 Jul 15.
Personalized radiofrequency (RF) ablation for paroxysmal atrial fibrillation (PAF), adapting the ablation index (AI) to local left atrial wall thickness (LAWT), proved to be highly efficient maintaining high arrhythmia-free survival rates. However, multicentre data are lacking. This multicentre, prospective, non-randomized study was conducted at 5 tertiary hospitals and sought to assess the safety, efficacy, and reproducibility of the LAWT-guided ablation for PAF.
Consecutive patients referred for first-time PAF were prospectively enrolled. The LAWT maps were obtained from preprocedural multidetector computed tomography and integrated into the navigation system. AI was titrated according to the local LAWT, and the ablation line was personalized to avoid the thickest regions while encircling the pulmonary veins (PVs).
A total 109 patients (60.1 ± 9.4 years, 64.2% male) were enrolled. Median procedure time was 61.7 min (48.4-83.8), fluoroscopy time was 1.0 min (0.4-3.3), and RF time was 13.9 min (12.3-16.8). Median AI tailored to the local LAWT was 393 (374-412) for the anterior wall and 340 (315-378) for the posterior wall. Right and left PVs first-pass isolation was achieved in 89% and 91.7% of the patients, respectively. At 12-month follow-up, freedom from any atrial arrhythmia was 93.4% (95% CI 88.7-98.1), without differences across centres (P = 0.169). One patient experienced femoral artery pseudoaneurysm, with no other serious procedural-related complication.
The Ablate-by-LAWT study proved that LAWT-guided PV isolation for PAF is safe, effective, and efficient in a multicentre setting. Twelve-month recurrence-free survival exceeded 90% (NCT04218604).
阵发性心房颤动（PAF）的个性化射频（RF）消融，通过调整消融指数（AI）以适应局部左心房壁厚度（LAWT），已被证明在维持高无心律失常生存率方面非常有效。然而，多中心数据尚缺。本多中心、前瞻性、非随机研究在5家三级医院开展，旨在评估LAWT指导下PAF消融的安全性、有效性和可重复性。
前瞻性纳入因首次PAF就诊的连续患者。术前通过多排螺旋计算机断层扫描获取LAWT图谱并整合到导航系统中。根据局部LAWT调整AI，并个性化制定消融线，以避开最厚区域同时环绕肺静脉（PVs）。
共纳入109例患者（60.1±9.4岁，64.2%为男性）。手术中位时间为61.7分钟（48.4 - 83.8），透视时间为1.0分钟（0.4 - 3.3），射频时间为13.9分钟（12.3 - 16.8）。根据局部LAWT调整后的前壁AI中位数为393（374 - 412），后壁为340（315 - 378）。分别有89%和91.7%的患者实现了右肺静脉和左肺静脉首次隔离。在12个月随访时，无任何房性心律失常的比例为93.4%（95%可信区间88.7 - 98.1），各中心之间无差异（P = 0.169）。1例患者出现股动脉假性动脉瘤，无其他严重的手术相关并发症。
LAWT指导下PAF的PV隔离在多中心环境中是安全、有效且高效的。12个月无复发生存率超过90%（NCT04218604）。
