Hybrid-Convergent 程序或脉冲场消融治疗慢性持续性心房颤动。

Hybrid-Convergent Procedure or Pulsed Field Ablation in Long-Standing Persistent Atrial Fibrillation.

机构信息

Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, Italy.

Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCSS, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

出版信息

JACC Clin Electrophysiol. 2024 Jul;10(7 Pt 2):1700-1710. doi: 10.1016/j.jacep.2024.05.029.

DOI:10.1016/j.jacep.2024.05.029

PMID:39084744

Abstract

BACKGROUND

Hybrid-convergent radiofrequency (RF) ablation targeting pulmonary veins (PVs) and left atrial posterior wall (LAPW) has shown better arrhythmic outcomes than an endocardial-only RF strategy, despite higher rates of complications. Comparisons with extensive pulsed field ablation (PFA) are currently lacking.

OBJECTIVES

This study aimed to compare the efficacy and safety of the hybrid-convergent RF vs PFA of PVs and LAPW in long-standing persistent atrial fibrillation (LSPAF).

METHODS

Ninety-three consecutive LSPAF patients, treated with 2-step hybrid-convergent RF ablation (hybrid group, n = 49) or with PFA of PVs and LAPW (PFA group, n = 44) were enrolled. Primary efficacy endpoint was defined as any atrial tachyarrhythmias (ATA) recurrence after the 3-month blanking period, over a follow-up time of 12 months. Periprocedural adverse events and late complications during follow-up were deemed primary safety outcomes.

RESULTS

The hybrid and PFA groups had similar baseline characteristics; mean age was hybrid 63.8 ± 10.6 years vs PFA 66.0 ± 7.4 years; P = 0.105. PV and LAPW ablation were acutely successful in all patients. Step 1 hybrid-epicardial procedures were longer than PFA (166 [Q1-Q3: 140-205] minutes vs 107.5 [Q1-Q3: 82.5-12] minutes; P < 0.01). At 12-month follow-up, there was no difference in ATA recurrences between groups (hybrid 36.7% vs PFA 40.9%; P = 0.680; log-rank at survival analysis P = 0.539). After adjusting for confounders, a larger left atrial volume and recurrences during the blanking-period were predictors of ATA recurrences after ablation, regardless of procedural technique employed. PFA showed a better safety profile with a lower rate of major periprocedural complications compared with hybrid ablation (12% vs 0%; P = 0.028).

CONCLUSIONS

Hybrid-convergent and PFA share comparable arrhythmic outcomes in LSPAF, but hybrid-convergent ablation carries higher periprocedural risks.

摘要

背景

与单纯的心内膜射频（RF）消融策略相比，针对肺静脉（PVs）和左心房后壁（LAPW）的混合汇聚式 RF 消融在心律失常方面显示出更好的效果，尽管并发症发生率更高。目前尚缺乏与广泛脉冲场消融（PFA）的比较。

目的

本研究旨在比较混合汇聚式 RF 与 PFA 消融治疗长程持续性心房颤动（LSPAF）中 PVs 和 LAPW 的疗效和安全性。

方法

连续纳入 93 例 LSPAF 患者，分别接受 2 步混合汇聚式 RF 消融（混合组，n=49）或 PFA 消融 PVs 和 LAPW（PFA 组，n=44）。主要疗效终点定义为 3 个月空白期后的任何房性快速性心律失常（ATA）复发，随访时间为 12 个月。围手术期不良事件和随访期间的迟发性并发症被认为是主要安全性结局。

结果

混合组和 PFA 组的基线特征相似；平均年龄分别为 63.8±10.6 岁和 66.0±7.4 岁；P=0.105。所有患者的 PV 和 LAPW 消融均即刻成功。与 PFA 相比，混合组的第 1 步心外膜程序更长（166[Q1-Q3：140-205]min 比 107.5[Q1-Q3：82.5-12]min；P<0.01）。12 个月随访时，两组间 ATA 复发无差异（混合组 36.7%，PFA 组 40.9%；P=0.680；生存分析中的对数秩检验 P=0.539）。在校正混杂因素后，左心房容积较大和空白期内的复发是消融后 ATA 复发的预测因素，与所采用的手术技术无关。与混合消融相比，PFA 显示出更好的安全性，主要围手术期并发症发生率较低（12%比 0%；P=0.028）。