持续性心房颤动的表型与消融结果：初发持续性房颤与阵发性房颤进展而来的持续性房颤

Persistent Atrial Fibrillation Phenotypes and Ablation Outcomes: Persistent From Outset vs Progression From Paroxysmal AF.

作者信息

Crowley Rose, Chieng David, Segan Louise, William Jeremy, Sugumar Hariharan, Prabhu Sandeep, Voskoboinik Aleksandr, Ling Liang-Han, Morton Joseph B, Lee Geoffrey, McLellan Alex J, Wong Michael, Pathak Rajeev K, Sterns Laurence, Ginks Matthew, Sanders Prashanthan, Kistler Peter M, Kalman Jonathan M

机构信息

Department of Cardiology, The Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.

Department of Cardiology, The Alfred Hospital, Melbourne, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Australia; Monash School of Medicine, Monash University, Melbourne, Australia.

出版信息

JACC Clin Electrophysiol. 2025 Jan;11(1):10-18. doi: 10.1016/j.jacep.2024.09.018. Epub 2024 Sep 27.

DOI:10.1016/j.jacep.2024.09.018

PMID:39453295

Abstract

BACKGROUND

Many patients with persistent atrial fibrillation (PsAF) have progressed from an initial paroxysmal phenotype; however, there are patients in whom atrial fibrillation (AF) is persistent at diagnosis. Relatively little is known about this subgroup, but prior observational studies have suggested these patients have worse outcomes with ablation.

OBJECTIVES

This study sought to: 1) assess demographic and electrophysiologic characteristics of patients with PsAF at first diagnosis compared with those with who have progressed from paroxysmal atrial fibrillation (PAF); and 2) assess the impact of pattern of AF at diagnosis on recurrence post ablation.

METHODS

CAPLA (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]) was a multicenter trial that randomized patients with PsAF to PVI plus PWI or PVI alone. Follow-up was 12 months. Outcomes were assessed after a 3-month blanking period.

RESULTS

A total of 334 patients were included (median age 65.6 years, 23.1% female), 194 (58.1%) had PsAF at first AF diagnosis and 140 (41.9%) had PAF. Patients with PsAF at diagnosis were younger (age 64.0 vs 67.7 years, P = 0.005), had higher rates of heart failure (P < 0.001), and lower left ventricular ejection fraction (54.5%, IQR: 40%-60% vs 60%, IQR: 50%-61%, P = 0.007). AF recurrence occurred in 85 (43.8%) with PsAF at diagnosis and 70 (50%) with PAF at diagnosis. PsAF at diagnosis was not associated with risk of recurrence on univariable (HR: 0.802; 95% CI: 0.585-1.101; P = 0.173) or multivariable analysis (HR: 0.922; 95% CI: 0.647-1.312; P = 0.650). Median AF burden was 0% in both groups (P = 0.125). There was no difference in left atrial size (P = 0.337) or bipolar voltage (P = 0.579) between the groups.

CONCLUSIONS

In the CAPLA cohort of patients, pattern of AF at first diagnosis did not influence post-ablation rate of AF recurrence or AF burden. (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]; ACTRN12616001436460).

摘要

背景

许多持续性房颤（PsAF）患者是从最初的阵发性表型发展而来；然而，也有一些患者在诊断时即为持续性房颤（AF）。关于这一亚组患者的情况相对了解较少，但既往观察性研究表明，这些患者接受消融治疗的预后较差。

目的

本研究旨在：1）评估首次诊断为PsAF的患者与从阵发性房颤（PAF）进展而来的患者的人口统计学和电生理特征；2）评估诊断时房颤类型对消融术后复发的影响。

方法

CAPLA（持续性房颤导管消融：肺静脉隔离[PVI]与肺静脉隔离加左心房后壁隔离[PWI]的多中心随机试验）是一项多中心试验，将PsAF患者随机分为PVI加PWI组或单纯PVI组。随访12个月。在3个月的空白期后评估结果。

结果

共纳入334例患者（中位年龄65.6岁，女性占23.1%），194例（58.1%）在首次房颤诊断时为PsAF，140例（41.9%）为PAF。诊断时为PsAF的患者更年轻（年龄64.0岁对67.7岁，P = 0.005），心力衰竭发生率更高（P < 0.001），左心室射血分数更低（54.5%，四分位数间距：40% - 60%对60%，四分位数间距：50% - 61%，P = 0.007）。诊断时为PsAF的患者中有85例（43.8%）发生房颤复发，诊断时为PAF的患者中有70例（50%）发生房颤复发。诊断时为PsAF与单变量分析（风险比：0.802；95%置信区间：0.585 - 1.101；P = 0.173）或多变量分析（风险比：0.922；95%置信区间：0.647 - 1.312；P = 0.650）的复发风险均无关联。两组的房颤负荷中位数均为0%（P = 0.125）。两组间左心房大小（P = 0.337）或双极电压（P = 0.579）无差异。