Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Fuwai Hospital, Chinese Academy of Medical Sciences; Fuwai Shenzhen Hospital,Chinese Academy of Medical Sciences, Beijing, People's Republic of China
Open Heart. 2024 Sep 19;11(2):e002873. doi: 10.1136/openhrt-2024-002873.
The value of empirical superior vena cava isolation (SVCI) following pulmonary vein isolation (PVI) to improve the efficacy of radiofrequency catheter ablation (RFCA) for paroxysmal atrial fibrillation (PAF) remains controversial.
To evaluate the efficacy and safety of quantitative ablation index (AI)-guided empirical SVCI, in addition to PVI, for patients with PAF.
Patients with symptomatic PAF who underwent RFCA between October 2021 and May 2023 were retrospectively analysed. Patients were categorised into PVI-only group and PVI+SVCI group based on the intraoperative ablation strategy. RFCA was guided by quantitative AI in both groups. Regular clinical follow-ups were conducted to detect AF recurrence, defined as any episode of atrial fibrillation, atrial flutter or atrial tachycardia lasting >30 s.
A total of 246 patients were enrolled, with 108 patients in the PVI group and 138 patients in the PVI+SVCI group. Compared with the PVI group, patients in the PVI+SVCI group had a higher prevalence of coronary artery disease (p=0.04), stroke (p=0.02) and a smaller left atrial diameter (p<0.01). After a follow-up period of 16±6 months, the ablation success rate was significantly higher in the SVCI+PVI group compared with the PVI group (91.3% vs 81.5%, p=0.02). Multivariable logistic regression analysis indicated that SVCI was an independent predictor of reduced AF recurrence postablation (Relative Risk [RR] 0.4, 95% CI 0.19 to 0.90, p=0.026). No significant difference in complication rates was observed between the groups.
Quantitative AI-guided empirical SVCI, in addition to PVI, improves the success rate of RFCA for PAF without increasing the risk of complications.
在肺静脉隔离（PVI）后进行经验性上腔静脉隔离（SVCI）以提高阵发性心房颤动（PAF）射频导管消融（RFCA）的疗效，其价值仍存在争议。
评估定量消融指数（AI）指导的经验性SVCI 除 PVI 以外，对 PAF 患者的疗效和安全性。
回顾性分析 2021 年 10 月至 2023 年 5 月期间接受 RFCA 的症状性 PAF 患者。根据术中消融策略，将患者分为 PVI 组和 PVI+SVCI 组。两组均采用定量 AI 指导 RFCA。定期进行临床随访，以检测 AF 复发，定义为任何持续 >30s 的心房颤动、心房扑动或房性心动过速发作。
共纳入 246 例患者，其中 PVI 组 108 例，PVI+SVCI 组 138 例。与 PVI 组相比，PVI+SVCI 组患者冠心病（p=0.04）、卒中（p=0.02）的患病率更高，左心房直径更小（p<0.01）。随访 16±6 个月后，SVCI+PVI 组消融成功率明显高于 PVI 组（91.3% vs 81.5%，p=0.02）。多变量逻辑回归分析表明，SVCI 是消融后 AF 复发减少的独立预测因素（相对风险 [RR] 0.4，95%可信区间 0.19 至 0.90，p=0.026）。两组并发症发生率无显著差异。
在 PVI 基础上，采用定量 AI 指导经验性 SVCI 可提高 PAF 的 RFCA 成功率，且不会增加并发症风险。
