Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, Liaoning, 116011, China.
BMC Cardiovasc Disord. 2024 Nov 20;24(1):658. doi: 10.1186/s12872-024-04332-w.
To explore the safety and efficacy of a novel strategy (bi-atrial linear catheter ablation guided by electrophysiological mapping) for persistent atrial fibrillation (PeAF) treatment.
83 patients with PeAF were enrolled for evaluation of ablation strategy. 43 patients were subjected to pulmonary vein isolation (PVI) strategy (PVI group). 40 patients were subjected to bi-atrial linear ablation strategy guided by electrophysiological mapping (PVI, left atrial BOX ablation, coronary sinus endocardial linear ablation, tailored left atrial anterior wall linear ablation, mitral isthmus linear ablation with necessary ethanol infusion into the vein of Marshall, right atrial posterior wall linear ablation and cavo-tricuspid isthmus ablation) (linear ablation group). Patients were followed up every 3 months.
During a median follow-up of 12 (4-16) months, freedom from atrial fibrillation/atrial tachycardia recurrence was 87.5% in the linear ablation group and 65.1% in the PVI group (P < 0.01). A Cox regression multivariate analysis revealed that ablation strategy group (tailored bi-atrial linear ablation) (HR 0.33, 95% CI 0.12-0.91, P = 0.03) was the only independent predictor of recurrence.
Tailored bi-atrial linear ablation strategy guided by electrophysiological mapping resulted in improved outcomes without compromising safety for patients with PeAF.
探讨一种新策略（基于电生理标测的双心房线性导管消融）治疗持续性心房颤动（PeAF）的安全性和有效性。
纳入 83 例 PeAF 患者评估消融策略。43 例患者接受肺静脉隔离（PVI）策略（PVI 组）。40 例患者接受基于电生理标测的双心房线性消融策略（PVI、左心房 BOX 消融、冠状静脉窦心内膜线性消融、定制左心房前壁线性消融、二尖瓣峡部线性消融，必要时向 Marshall 静脉内输注乙醇、右心房后壁线性消融和腔静脉峡部消融）（线性消融组）。患者每 3 个月随访一次。
在中位数为 12（4-16）个月的随访期间，线性消融组无房性颤动/房性心动过速复发率为 87.5%，PVI 组为 65.1%（P<0.01）。Cox 回归多变量分析显示，消融策略组（定制双心房线性消融）（HR 0.33，95%CI 0.12-0.91，P=0.03）是复发的唯一独立预测因素。
基于电生理标测的定制双心房线性消融策略可改善持续性心房颤动患者的预后，同时不影响安全性。
