心脏淀粉样变性和结节病患者心房颤动的导管消融：手术结果和预后
Catheter ablation of atrial fibrillation in patients with cardiac amyloidosis and sarcoidosis: procedural findings and outcomes.
作者信息
Oraii Alireza, Hanumanthu Balaram Krishna J, Petzl Adrian, Liao Ting-Wei, Afzalian Arian, Rodriguez-Queralto Oriol, Chaumont Corentin, Spears Jenna, Markman Timothy M, Hyman Matthew C, Tschabrunn Cory M, Guandalini Gustavo, Enriquez Andres, Shivamurthy Poojita, Kumareswaran Ramanan, Deo Rajat, Ferrari Victor A, Riley Michael P, Lin David, Callans David J, Supple Gregory E, Schaller Robert D, Frankel David S, Garcia Fermin C, Nazarian Saman, Dixit Sanjay, Marchlinski Francis E
机构信息
Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, 1 Convention Ave, Pavilion - 2nd floor City Side, Philadelphia, PA 19104, USA.
出版信息
Europace. 2025 Jun 3;27(6). doi: 10.1093/europace/euaf100.
AIMS
The diagnosis of infiltrative cardiomyopathies has increased over last years. Catheter ablation is becoming the preferred approach for managing atrial fibrillation (AF) in these patients. This study aims to characterize differences in procedural findings during AF ablation in patients with and without infiltrative cardiomyopathies.
METHODS AND RESULTS
Patients with cardiac amyloidosis and cardiac sarcoidosis undergoing first-time AF ablation were propensity score matched in 1:4 ratio to separate reference groups that received trigger provocative manoeuvres (isoproterenol infusion and/or atrial burst pacing) and had no prior cardiac surgery. Non-pulmonary vein (PV) triggers [defined as ectopic foci initiating AF or sustained focal atrial tachycardia (AT)] and macro-reentrant atrial flutters (AFLs) were then mapped and targeted. Recurrence was defined as AF/AT/AFL ≥ 30 s after 90-day blanking period. Twenty-four patients with cardiac amyloidosis were matched to 96 controls, and 17 patients with cardiac sarcoidosis were matched to 68 controls. Non-PV triggers were more frequent in patients with cardiac amyloidosis {29.2% vs. 8.3%; odds ratio [OR] = 4.5 [95% confidence interval (CI): 1.4-14.2]} and cardiac sarcoidosis [17.6% vs. 7.4%; OR = 2.7 (95% CI: 0.6-12.6)] compared with their reference groups. Patients with cardiac amyloidosis also had a higher incidence of left atrial macro-reentrant flutters [37.5% vs. 6.3%; OR = 9.0, (95% CI: 2.8-29.0)]. One-year recurrence rate was similar between patients with cardiac sarcoidosis and controls (33.3% vs. 33.9%; P = 0.965) but higher in patients with cardiac amyloidosis vs. controls (47.4% vs. 27.1%; P = 0.049).
CONCLUSION
Patients with infiltrative cardiomyopathies exhibit higher rates of non-PV triggers and left AFLs during first-time AF ablation. Those with cardiac amyloidosis experience higher arrhythmia recurrence rates compared with controls.
目的
近年来，浸润性心肌病的诊断率有所上升。导管消融正成为这些患者管理心房颤动（AF）的首选方法。本研究旨在描述浸润性心肌病患者与非浸润性心肌病患者在房颤消融过程中手术结果的差异。
方法与结果
将首次接受房颤消融的心脏淀粉样变性和心脏结节病患者按1:4的比例进行倾向评分匹配，分为接受触发激发操作（异丙肾上腺素输注和/或心房猝发起搏）且既往无心脏手术史的对照组。然后对非肺静脉（PV）触发灶[定义为引发房颤或持续性局灶性房性心动过速（AT）的异位灶]和大折返性房扑（AFL）进行标测和靶向治疗。复发定义为在90天空白期后房颤/房速/房扑≥30秒。24例心脏淀粉样变性患者与96例对照匹配，17例心脏结节病患者与68例对照匹配。与对照组相比，心脏淀粉样变性患者{29.2%对8.3%；比值比[OR]=4.5[95%置信区间（CI）：1.4 - 14.2]}和心脏结节病患者[17.6%对7.4%；OR = 2.7（95%CI：0.6 - 12.6）]的非PV触发灶更常见。心脏淀粉样变性患者左房大折返性房扑的发生率也更高[37.5%对6.3%；OR = 9.0，（95%CI：2.8 - 29.0）]。心脏结节病患者与对照组的1年复发率相似（33.3%对33.9%；P = 0.965），但心脏淀粉样变性患者的复发率高于对照组（47.4%对
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