持续性房颤的诊断与消融：任何时候都是消融的好时机。

Diagnosis to Ablation in Persistent AF: Any Time Can Be a Good Time to Ablate.

机构信息

University of Melbourne, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia.

University of Melbourne, Melbourne, Victoria, Australia; Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia.

出版信息

JACC Clin Electrophysiol. 2024 Jul;10(7 Pt 2):1689-1699. doi: 10.1016/j.jacep.2024.05.031.

DOI:10.1016/j.jacep.2024.05.031

PMID:39084743

Abstract

BACKGROUND

Nonrandomized data suggest that longer diagnosis-to-ablation time (DAT) is associated with poorer outcomes; however, a recent randomized trial found no difference in recurrences when ablation was delayed by 12 months.

OBJECTIVES

This study sought to assess the impact of DAT on atrial fibrillation (AF) recurrence in patients undergoing catheter ablation for persistent AF.

METHODS

CAPLA (Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The CAPLA randomized clinical trial) was a multicenter trial that randomized patients with persistent AF to pulmonary vein isolation + posterior wall isolation or pulmonary vein isolation alone. Follow-up was 12 months. Outcomes were assessed after a 3-month blanking period.

RESULTS

Median DAT in the 334 patients was 28 months (Q1-Q3: 12-66 months). Patients were divided into quartile groups: Q1 was DAT 0 to 12 months (n = 84, median DAT 7 months), Q2 was DAT 13 to 28 months (n = 85, median DAT 20 months), Q3 was DAT 29 to 66 months (n = 84, median DAT 41 months), and Q4 was DAT ≥67 months (n = 81, median DAT 119 months). AF recurrence rate was 36.9% for Q1, 44.7% for Q2, 47.6% for Q3, and 56.8% for Q4 (P = 0.082). On multivariable analysis, DAT Q4 was the only factor significantly associated with risk of recurrence (HR: 1.607; 95% CI: 1.005-2.570; P = 0.048). Median AF burden was 0% (Q1-Q3: 0%-0.47%) in Q1 and 0.33% (Q1-Q3: 0%-4.6%) in Q4 (P = 0.002). Quality of life (assessed by the Atrial Fibrillation Effect on Quality-of-Life questionnaire) improved markedly in all quartiles (Q1: Δ28.8 ± 24, Q2: Δ24.4 ± 23.4, Q3: Δ21.7 ± 26.6, Q4: Δ24.6 ± 21.4; P = 0.331).

CONCLUSIONS

In a cohort of patients with persistent AF undergoing ablation in a prospective trial with standardized entry criteria and intensive electrocardiogram monitoring, those with shorter DAT had lower rates of AF recurrence. However, differences were modest, and all quartiles demonstrated very low AF burden and improvements in quality of life.

摘要

背景

非随机数据表明，诊断至消融时间（DAT）较长与预后较差相关；然而，最近的一项随机试验发现，当消融延迟 12 个月时，复发率没有差异。

目的

本研究旨在评估 DAT 对持续性心房颤动（AF）患者接受导管消融后 AF 复发的影响。

方法

CAPLA（使用肺静脉隔离与不隔离左心房后壁对持续性心房颤动患者的心房心律失常复发的影响：CAPLA 随机临床试验）是一项多中心试验，将持续性 AF 患者随机分为肺静脉隔离+后壁隔离组或肺静脉隔离组。随访 12 个月。在 3 个月的空白期后评估结果。

结果

334 例患者的中位 DAT 为 28 个月（Q1-Q3：12-66 个月）。患者被分为四分位组：Q1 为 DAT 0 至 12 个月（n=84，中位 DAT 7 个月），Q2 为 DAT 13 至 28 个月（n=85，中位 DAT 20 个月），Q3 为 DAT 29 至 66 个月（n=84，中位 DAT 41 个月），Q4 为 DAT≥67 个月（n=81，中位 DAT 119 个月）。Q1 的 AF 复发率为 36.9%，Q2 为 44.7%，Q3 为 47.6%，Q4 为 56.8%（P=0.082）。多变量分析显示，DAT Q4 是唯一与复发风险显著相关的因素（HR：1.607；95%CI：1.005-2.570；P=0.048）。Q1 的 AF 负荷中位数为 0%（Q1-Q3：0%-0.47%），Q4 为 0.33%（Q1-Q3：0%-4.6%）（P=0.002）。所有四分位组的生活质量（通过心房颤动对生活质量问卷评估）均显著改善（Q1：Δ28.8±24，Q2：Δ24.4±23.4，Q3：Δ21.7±26.6，Q4：Δ24.6±21.4；P=0.331）。