Ding Xueyan, Zhao Yao, Dong Shaohua, Huang Xinmiao, Qin Aihong, Cao Jiang, Guo Zhifu, Huang Songqun
Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016 Hangzhou, Zhejiang, China.
Department of Cardiovasology, Changhai Hospital, Second Military Medical University, 200433 Shanghai, China.
Rev Cardiovasc Med. 2024 Jan 9;25(1):10. doi: 10.31083/j.rcm2501010. eCollection 2024 Jan.
The combination of left atrial appendage closure (LAAC) and catheter ablation (CA) in a single procedure is a safe and effective form of treatment for atrial fibrillation (AF). However, several findings have argued that LAAC might increase the risk of AF recurring. Therefore, this study investigated the impact of insufficient ablation on AF recurrence after the hybrid procedures of CA and LAAC.
We reviewed 107 consecutive patients with AF who received the CA and LAAC hybrid procedures (combined group). In the case-control study, another 107 patients who underwent only CA (ablation group) were successfully matched using propensity score matching. After correcting the insufficient ablation, 107 consecutive patients were enrolled prospectively. During the follow-up period, postprocedural 24-hour monitor recordings and a portable electrocardiogram (ECG) monitoring device were used to detect AF recurrence. Transesophageal echocardiography was used to evaluate LAAC.
The combined group showed an increase in the risk of AF recurrence after 539.2 304.4 days of follow-up (29.9% vs. 15.9%, 0.05). Interestingly, the duration of the procedure was not significantly prolonged when LAAC was added after CA in the combined group, while there was a higher number of ablating attempts, duration of ablation, and additional ablation in the ablation group for both radiofrequency and cryoballoon ablation. After correcting for the insufficient ablation, the corrected group showed a significant decrease in AF recurrence after 420.4 204.8 days of follow-up.
Insufficient ablation is common when combining CA and LAAC and may lead to the recurrence of atrial fibrillation. It should be corrected intentionally by sufficient ablation of the pulmonary vein antrum and additional ablation.
The prospective study is a sub-study of our CAGEDAF study that has already been registered (ChiCTR2000039746).
在同一次手术中联合进行左心耳封堵术（LAAC）和导管消融术（CA）是治疗心房颤动（AF）的一种安全有效的方法。然而，一些研究结果表明LAAC可能会增加房颤复发的风险。因此，本研究调查了CA和LAAC联合手术后消融不足对房颤复发的影响。
我们回顾了107例连续接受CA和LAAC联合手术的房颤患者（联合组）。在病例对照研究中，使用倾向评分匹配成功匹配了另外107例仅接受CA的患者（消融组）。在纠正消融不足后，前瞻性纳入了107例连续患者。在随访期间，使用术后24小时监测记录和便携式心电图（ECG）监测设备检测房颤复发。经食管超声心动图用于评估LAAC。
联合组在随访539.2±304.4天后房颤复发风险增加（29.9%对15.9%，P<0.05）。有趣的是，联合组在CA后加做LAAC时手术时间并未显著延长，而消融组在射频消融和冷冻球囊消融方面的消融尝试次数、消融持续时间和额外消融次数更多。在纠正消融不足后，校正组在随访420.4±204.8天后房颤复发显著减少。
CA和LAAC联合应用时消融不足很常见，可能导致房颤复发。应通过充分消融肺静脉前庭和额外消融来有意纠正。
本前瞻性研究是我们已注册的CAGEDAF研究的子研究（ChiCTR2000039746）。
