Lepillier Antoine, Pineau Julien, Otmani Akli, Durand Cyril, Waintraub Xavier, Zakine Cyril, Niro Marjorie, Moubarak Ghassan, Zhao Alexandre, Bars Clément, Badenco Nicolas, Escande William, Macaluso Gilles, Piot Olivier
Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
Cardiology Department, Hopital St Luc St Joseph, Lyon, France.
Heart Rhythm. 2025 Jun 3. doi: 10.1016/j.hrthm.2025.05.064.
Targeting low-voltage areas (LVAs) in addition to pulmonary vein isolation (PVI) can improve ablation outcome in persistent atrial fibrillation (AF).
SCAR-AF was a multicenter, prospective, randomized trial, evaluating LVA ablation plus PVI for persistent AF.
Patients with de novo persistent AF were recruited (9 referral centers in France) into the SCAR-AF study (September 2019 to August 2021). Patients without LVA were treated with PVI alone (PVI-), and those with LVA were randomized to either PVI alone (PVI+) or PVI plus LVA ablation (PVI + LVA). The primary outcome was freedom from atrial arrhythmias (AF/atrial tachycardia) after a single procedure.
A total of 211 patients (73.5% men, mean ± standard deviation age 63.8 ± 9.3 years, CHADS-VASc score 2.1, long-standing AF 44.5%) were included. At 18-month follow-up, the incidence of atrial-arrhythmia-free survival did not differ between groups (79.0% in PVI-, 75.7% in PVI+, and 73.1% in PVI + LVA; PVI- vs PVI+, hazard ratio (HR) 1.28, 95% confidence interval [CI] 0.64-2.55, P = .48; PVI+ vs PVI + LVA, HR 1.28; 95% CI 0.67-2.45, P = .45). On multivariable analysis, presence of LVA was associated with advancing age (HR 1.11, 95% CI 1.06-1.16, P < .001) and was inversely correlated with body mass index (HR 0.93, 95% CI 0.87-0.99, P = .029) and smoking.
In this randomized trial, PVI plus LVA ablation did not improve outcomes in patients with persistent AF. LVA may represent a marker of atrial cardiomyopathy, but its presence does not seem to be an effective target in persistent AF.
除肺静脉隔离（PVI）外，针对低电压区域（LVA）可改善持续性心房颤动（AF）的消融效果。
SCAR-AF是一项多中心、前瞻性、随机试验，评估LVA消融联合PVI治疗持续性AF的效果。
招募初发持续性AF患者（法国9个转诊中心）纳入SCAR-AF研究（2019年9月至2021年8月）。无LVA的患者仅接受PVI治疗（PVI-），有LVA的患者随机分为仅接受PVI治疗（PVI+）或PVI联合LVA消融治疗（PVI + LVA）。主要结局是单次手术后无房性心律失常（AF/房性心动过速）。
共纳入211例患者（男性占73.5%，平均±标准差年龄63.8±9.3岁，CHADS-VASc评分2.1，长期AF占44.5%）。在18个月的随访中，各组无房性心律失常生存的发生率无差异（PVI-组为79.0%，PVI+组为75.7%，PVI + LVA组为73.1%；PVI-组与PVI+组比较，风险比[HR]为1.28，95%置信区间[CI]为0.64 - 2.55，P = 0.48；PVI+组与PVI + LVA组比较，HR为1.28；95%CI为0.67 - 2.45，P = 0.45）。多变量分析显示，LVA的存在与年龄增长相关（HR为1.11，95%CI为1.06 - 1.16，P < 0.001），与体重指数呈负相关（HR为0.93，95%CI为0.87 - 0.99，P = 0.029），与吸烟呈负相关。
在这项随机试验中，PVI联合LVA消融并未改善持续性AF患者的结局。LVA可能代表心房心肌病的一个标志物，但其存在似乎并非持续性AF的有效治疗靶点。
