阵发性心房颤动消融术中高频低潮气量通气联合快速心房起搏的手术及临床结果
Procedural and Clinical Outcomes of High-Frequency Low-Tidal Volume Ventilation Plus Rapid-Atrial Pacing in Paroxysmal Atrial Fibrillation Ablation.
作者信息
Zei Paul C, Hincapie Daniela, Rodriguez-Taveras Joan, Osorio Jose, Alviz Isabella, Miranda-Arboleda Andres F, Gabr Mohamed, Thorne Christopher, Silverstein Joshua R, Thosani Amit J, Varley Allyson L, Moreno Fernando, Zapata Daniel A, D'Souza Benjamin, Rajendra Anil, Oza Saumil, Linda Justice R N, Baranowski Ana, Phan Huy, Velasco Alejandro, Te Charles C, Sackett Matthew C, Singleton Matthew J, Magnano Anthony R, Singh David, Kuk Richard, Steiger Nathaniel A, Sauer William H, Romero Jorge E
机构信息
Harvard Medical School, Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Medicine, Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
出版信息
J Cardiovasc Electrophysiol. 2025 Jul;36(7):1461-1471. doi: 10.1111/jce.16661. Epub 2025 Apr 18.
BACKGROUND
High-frequency low-tidal-volume (HFLTV) ventilation is a safe and cost-effective strategy that improves catheter stability, first-pass pulmonary vein isolation, and freedom from all-atrial arrhythmias during radiofrequency catheter ablation (RFCA) of paroxysmal and persistent atrial fibrillation (AF). However, the incremental value of adding rapid-atrial pacing (RAP) to HFLTV-ventilation has not yet been determined.
OBJECTIVE
To evaluate the effect of HFLTV-ventilation plus RAP during RFCA of paroxysmal AF on procedural and long-term clinical outcomes compared to HFLTV-ventilation alone.
METHODS
Patients from the REAL-AF prospective multicenter registry, who underwent RFCA of paroxysmal AF using either HFLTV + RAP (500-600 msec) or HFLTV ventilation alone from April 2020 to February 2023 were included. The primary outcome was freedom from all-atrial arrhythmias at 12-month follow-up. Secondary outcomes included procedural characteristics, long-term clinical outcomes, and procedure-related complications.
RESULTS
A total of 545 patients were included in the analysis (HFLTV + RAP = 327 vs. HFLTV = 218). There were no significant differences in baseline characteristics between the groups. No differences were observed in procedural (HFLTV + RAP 74 [57-98] vs. HFLTV 66 [53-85.75] min, p = 0.617) and RF (HFLTV + RAP 15.15 [11.22-21.22] vs. HFLTV 13.99 [11.04-17.13] min, p = 0.620) times. Both groups showed a similar freedom from all-atrial arrhythmias at 12-month follow-up (HFLTV + RAP 82.68% vs. HFLTV 86.52%, HR = 1.43, 95% CI [0.94-2.16], p = 0.093). There were no significant differences in freedom from AF-related symptoms (HFLTV + RAP 91.4% vs. HFLTV 93.1%, p = 0.476) or AF-related hospitalizations (HFLTV + RAP 98.5% vs. HFLTV 97.2%, p = 0.320). Procedure-related complications were low in both groups (HFLTV + RAP 0.6% vs. HFLTV 0%, p = 0.247).
CONCLUSION
In patients undergoing RFCA for paroxysmal AF, adding RAP to HFLTV-ventilation was not associated with improved procedural and long-term clinical outcomes.
背景
高频低潮气量（HFLTV）通气是一种安全且具有成本效益的策略，可提高导管稳定性、首次肺静脉隔离成功率，并在阵发性和持续性心房颤动（AF）的射频导管消融（RFCA）过程中减少所有房性心律失常的发生。然而，在HFLTV通气基础上加用快速心房起搏（RAP）的额外价值尚未确定。
目的
评估与单独使用HFLTV通气相比，在阵发性AF的RFCA过程中HFLTV通气加RAP对手术及长期临床结局的影响。
方法
纳入2020年4月至2023年2月期间在REAL-AF前瞻性多中心注册研究中接受阵发性AF的RFCA治疗的患者，这些患者使用HFLTV + RAP（500 - 600毫秒）或仅使用HFLTV通气。主要结局是随访12个月时无所有房性心律失常。次要结局包括手术特征、长期临床结局和手术相关并发症。
结果
共545例患者纳入分析（HFLTV + RAP组 = 327例，HFLTV组 = 218例）。两组间基线特征无显著差异。手术时间（HFLTV + RAP组74 [57 - 98]分钟 vs. HFLTV组66 [53 - 85.75]分钟，p = 0.617）和射频时间（HFLTV + RAP组15.15 [11.22 - 21.22]分钟 vs. HFLTV组13.99 [11.04 - 17.13]分钟，p = 0.620）均无差异。两组在随访12个月时无所有房性心律失常的情况相似（HFLTV + RAP组82.68% vs. HFLTV组86.52%，HR = 1.43，95%CI [0.94 - 2.16]，p = 0.093）。在无AF相关症状（HFLTV + RAP组91.4% vs. HFLTV组93.1%，p = 0.476）或AF相关住院（HFLTV + RAP组98.5% vs. HFLTV组97.2%，p = 0.320）方面无显著差异。两组手术相关并发症发生率均较低（HFLTV + RAP组0.6% vs. HFLTV组0%，p = 0.247）。
结论
在接受阵发性AF的RFCA治疗的患者中，在HFLTV通气基础上加用RAP与改善手术及长期临床结局无关。
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