Bergonti Marco, Krisai Philipp, Ascione Ciro, Pambrun Thomas, Della Rocca Domenico G, Compagnucci Paolo, Özkartal Tardu, Marcon Lorenzo, Ferrero Teba Gonzalez, Pannone Luigi, Kühne Michael, Anselmino Matteo, Casella Michela, Serban Teodor, Tondo Claudio, Rodríguez-Mañero Moises, Caputo Maria Luce, Badertscher Patrick, Derval Nicolas, de Asmundis Carlo, Chierchia Gian Battista, Heidbuchel Hein, Jaïs Pierre, Auricchio Angelo, Sarkozy Andrea, Conte Giulio
Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland.
Cardiology Division, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
JACC Clin Electrophysiol. 2025 May;11(5):942-952. doi: 10.1016/j.jacep.2024.12.004. Epub 2025 Jan 29.
Catheter ablation of atrial fibrillation has been proven beneficial in patients with heart failure and reduced ejection fraction (HFrEF). On top of pulmonary vein isolation (PVI), additional ablation strategies such as empirical lines/posterior box/low voltage ablation (PVI+L/LVA) are often used. Whether PVI+L/LVA provides additional benefits in this population has never been systematically investigated.
This study sought to analyze the temporal trends and comparative outcomes of PVI+L/LVA vs PVI alone.
Patients with HFrEF undergoing atrial fibrillation ablation were retrospectively enrolled. The 2 coprimary endpoints were ventricular function recovery and atrial fibrillation recurrence-free survival at 1 year. The performance of PVI and PVI+L/LVA was compared in the overall population and in 2 matched groups. A sensitivity analysis for measured confounders was performed.
A total of 955 HFrEF patients (age 62.1 years, 24.4% female) from 9 international centers were included (PVI only 51.6% vs PVI+L/LVA 48.4%). At 12 months after the procedure, 62.3% of the patients remained free from arrhythmia recurrences and 65.4% experienced ventricular function recovery. Comparing PVI to PVI+L/LVA, no significant difference in the 2 coprimary endpoints was observed, neither in the overall nor in the matched cohorts. The use of PVI+L/LVA increased from 27% in 2013 to 68% in 2022. Patients undergoing PVI+L/LVA experienced more complications (3.8 vs 1.2%; P = 0.018).
Catheter ablation is associated with significant improvements in systolic function, irrespective of the ablation strategy used. The use of PVI+L/LVA in HFrEF patients is progressively expanding over time. Although the benefits of this practice remain unproven, it is associated with an increased risk of overall and nonvascular complications. These results warrant caution regarding the growing use of PVI+ in HFrEF patients.
心房颤动导管消融已被证明对心力衰竭且射血分数降低（HFrEF）的患者有益。除肺静脉隔离（PVI）外，常采用其他消融策略，如经验性线性消融/后间隔盒式消融/低电压消融（PVI + L/LVA）。PVI + L/LVA在该人群中是否能带来额外益处从未得到系统研究。
本研究旨在分析PVI + L/LVA与单纯PVI的时间趋势及比较结果。
回顾性纳入接受心房颤动消融的HFrEF患者。两个共同主要终点为1年时心室功能恢复和无房颤复发存活。在总体人群和两个匹配组中比较PVI和PVI + L/LVA的效果。对测量的混杂因素进行敏感性分析。
纳入了来自9个国际中心的955例HFrEF患者（年龄62.1岁，24.4%为女性）（单纯PVI占51.6%，PVI + L/LVA占48.4%）。术后12个月时，62.3%的患者无心律失常复发，65.4%的患者心室功能恢复。比较PVI和PVI + L/LVA，在两个共同主要终点方面未观察到显著差异，无论是在总体人群还是匹配队列中。PVI + L/LVA的使用比例从2013年的27%增加到2022年的68%。接受PVI + L/LVA的患者发生更多并发症（3.8%对1.2%；P = 0.018）。
导管消融与收缩功能的显著改善相关，无论采用何种消融策略。HFrEF患者中PVI + L/LVA的使用随时间逐渐增加。尽管这种做法的益处尚未得到证实，但它与总体和非血管并发症风险增加相关。这些结果警示在HFrEF患者中越来越多地使用PVI + 时需谨慎。
