Kim Daehoon, Kwon Oh-Seok, Hwang Taehyun, Park Hanjin, Yu Hee Tae, Kim Tae-Hoon, Uhm Jae-Sun, Joung Boyoung, Lee Moon-Hyoung, Pak Hui-Nam
Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Europace. 2024 Dec 3;26(12). doi: 10.1093/europace/euae292.
Whether adjusting the duration of ablation based on left atrial wall thickness (LAWT) provides extra benefits for pulmonary vein (PV) isolation for atrial fibrillation (AF) is uncertain. We studied the safety and efficacy of tailored cryoballoon PV isolation (CB-PVI) based on LAWT for paroxysmal AF.
Two hundred seventy-seven patients with paroxysmal AF refractory to anti-arrhythmic drug were randomized 1:1 to either LAWT-guided CB-PVI (n = 135) and empirical CB-PVI (n = 142). Empirical CB-PVI was performed using a 28 mm cryoballoon with recommended application for 240 s per ablation. Cryoapplication in the LAWT-guided group was titrated (additional application for 120 s at PVs, where >25% of the circumference includes segments with LAWT > 2.5 mm and reduced baseline application to 180 s at PVs where >75% of the circumference includes segments with LAWT < 1.5 mm) according to the computed tomography LAWT colour map. The primary endpoint was freedom from any documented atrial arrhythmia of more than 30 s without antiarrhythmic medication, after a single ablation procedure. During a mean follow-up of 18.7 months, patients in the LAWT-guided CB-PVI group (70.8%) had a higher event-free rate from primary endpoint than those in the empirical CB-PVI group (54.4%; hazard ratio 0.64, 95% confidence interval 0.42-0.99; P = 0.043). No differences were observed between the groups in complication rates (3.0% in LAWT-guided vs. 4.9% in empirical CB-PVI). The total procedure time was extended in the LAWT group than in the empirical group (mean 70.2 vs. 65.2 min, respectively).
The LAWT-guided energy titration strategy improved freedom from atrial arrhythmia recurrence, compared with conventional strategy.
基于左心房壁厚度（LAWT）调整消融持续时间是否能为心房颤动（AF）的肺静脉（PV）隔离带来额外益处尚不确定。我们研究了基于LAWT的定制冷冻球囊PV隔离（CB - PVI）对阵发性AF的安全性和有效性。
277例对阵发性AF抗心律失常药物治疗无效的患者按1:1随机分为LAWT引导的CB - PVI组（n = 135）和经验性CB - PVI组（n = 142）。经验性CB - PVI使用28毫米冷冻球囊，每次消融推荐应用240秒。LAWT引导组的冷冻应用根据计算机断层扫描LAWT彩色图谱进行滴定（在肺静脉处额外应用120秒，此处周长的>25%包括LAWT>2.5毫米的节段，而在周长的>75%包括LAWT<1.5毫米节段的肺静脉处将基线应用时间减至180秒）。主要终点是单次消融术后无抗心律失常药物治疗情况下无任何记录在案的持续超过30秒的房性心律失常。在平均18.7个月的随访期间，LAWT引导的CB - PVI组患者（70.8%）的主要终点无事件发生率高于经验性CB - PVI组患者（54.4%；风险比0.64，95%置信区间0.42 - 0.99；P = 0.043）。两组并发症发生率无差异（LAWT引导组为3.0%，经验性CB - PVI组为4.9%）。LAWT组的总手术时间比经验性组延长（分别为平均70.2分钟和65.2分钟）。
与传统策略相比，LAWT引导的能量滴定策略提高了房性心律失常复发的自由度。
