Zhu Xuefeng, Fu Kaixuan, Wang Chunxiao, Ren Mengmeng, Li Wenjing, Chu Hongxia, Zhong Lin
Department of Cardiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, People's Republic of China.
Doppler Ultrasonic Department, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, People's Republic of China.
Heart Rhythm. 2025 Jul;22(7):e85-e91. doi: 10.1016/j.hrthm.2024.12.047. Epub 2025 Jan 7.
A significant proportion of patients with isolated atrial flutter will have atrial fibrillation (AF) after cavotricuspid isthmus (CTI) ablation.
The aim of this study was to determine whether concomitant pulmonary vein isolation (PVI) could reduce the incidence of new-onset AF (NOAF) in the setting of inducible AF after CTI ablation.
A total of 275 consecutive patients with isolated atrial flutter who successfully underwent CTI ablation were included. Patients were stratified into the induced AF group (55 patients) and the noninduced AF group (220 patients) on the basis of the inducibility of AF. Subsequently, the induced AF group was randomly divided into a PVI group (28 patients) and non-PVI (27 patients) group.
During 27.0 ± 6.0 months of follow-up, the PVI group (7.1% vs 51.9% [P < .001]; hazard ratio [HR], 0.103 [95% confidence interval for HR, 0.038-0.278; P < .001]) and noninduced AF group (13.2% vs 51.9% [P < .001]); HR, 0.207 [95% confidence interval for HR, 0.073-0.586; P < .001]) exhibited substantially lower incidence and risk of NOAF compared with the non-PVI group. Kaplan-Meier analysis showed that history of hypertension, cardiovascular disease, and heart failure and larger body mass index, larger left atrial diameter, and lower left ventricular ejection fraction were identified predictors of NOAF.
Inducibility of AF during CTI ablation is positively associated with an increased risk of NOAF, whereas concomitant PVI for induced AF can significantly reduce the incidence of NOAF.
相当一部分孤立性心房扑动患者在三尖瓣峡部（CTI）消融术后会发生心房颤动（AF）。
本研究旨在确定在CTI消融术后可诱发AF的情况下，同期行肺静脉隔离（PVI）是否能降低新发AF（NOAF）的发生率。
共纳入275例成功接受CTI消融的连续孤立性心房扑动患者。根据AF的可诱发性，将患者分为诱发性AF组（55例）和非诱发性AF组（220例）。随后，将诱发性AF组随机分为PVI组（28例）和非PVI组（27例）。
在27.0±6.0个月的随访期间，PVI组（7.1%对51.9%[P<.001]；风险比[HR]，0.103[HR的95%置信区间，0.038 - 0.278；P<.001]）和非诱发性AF组（13.2%对51.9%[P<.001]；HR，0.207[HR的95%置信区间，0.073 - 0.586；P<.001]）与非PVI组相比，NOAF的发生率和风险显著降低。Kaplan-Meier分析显示，高血压、心血管疾病和心力衰竭病史以及较高的体重指数、较大的左心房直径和较低的左心室射血分数是NOAF的确定预测因素。
CTI消融术中AF的可诱发性与NOAF风险增加呈正相关，而对于诱发性AF同期行PVI可显著降低NOAF的发生率。
