肾功能对肺静脉隔离术后低电压区消融疗效的影响：SUPPRESS-AF试验的亚组分析

Impact of renal function on the efficacy of low-voltage area ablation after pulmonary vein isolation: a sub-analysis of the SUPPRESS-AF trial.

作者信息

Matsuda Yasuhiro, Masuda Masaharu, Mano Toshiaki, Tsujimura Takuya, Uematsu Hiroyuki, Ooka Hirotaka, Kudo Satoshi, Ochi Mizuki, Okamoto Shin, Ishihara Takayuki, Nanto Kiyonori, Hata Yosuke, Nakao Sho, Kusuda Masaya, Ariyasu Wataru, Sunaga Akihiro, Tanaka Nobuaki, Watanabe Tetsuya, Minamiguchi Hitoshi, Egami Yasuyuki, Oka Takafumi, Minamisaka Tomoko, Kanda Takashi, Okada Masato, Kawasaki Masato, Tanaka Koji, Makino Nobuhiko, Kida Hirota, Hikoso Shungo, Dohi Tomoharu, Inoue Koichi, Sotomi Yohei, Sakata Yasushi

机构信息

Cardiovascular Center, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki 660-8511, Japan.

Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.

出版信息

Europace. 2025 Sep 1;27(9). doi: 10.1093/europace/euaf205.

DOI:10.1093/europace/euaf205

PMID:40892973

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12448949/

Abstract

AIMS

The SUPPRESS-AF trial showed that pulmonary vein isolation (PVI) plus low-voltage area (LVA) ablation may reduce atrial fibrillation (AF) recurrence in some subgroups. Renal dysfunction is a cause of LVAs due to atrial cardiomyopathy and is also a risk factor for AF recurrence after catheter ablation. The aim of this study was to investigate the efficacy of LVA ablation after PVI stratified by renal function.

METHODS AND RESULTS

This study was a sub-analysis of the SUPPRESS-AF trial, a multicentre, prospective, randomized, open-label trial. A total of 341 consecutive patients who underwent initial radiofrequency catheter ablation for persistent AF and whose LVAs were ≥5 cm2 were analysed. Patients were randomized to PVI alone (PVI-alone group) or LVA ablation after PVI [PVI + LVA-ablation (ABL) group]. Primary outcome was defined as the recurrence of atrial tachyarrhythmias during the 12 months following ablation. Estimated glomerular filtration rate (eGFR) was assessed before ablation, and patients were stratified by chronic kidney disease (CKD) stage. The mean eGFR was 60 ± 16 mL/min/1.73 m2, and 146 (43%) patients developed the primary outcome. In patients with CKD G1-2 (eGFR ≥ 60 mL/min/1.73 m2), freedom from the primary outcome was similar between the PVI + LVA-ABL and PVI-alone groups (53.1% vs. 55.3%, P = 0.59). In contrast, in patients with CKD G3a-5 (eGFR < 60 mL/min/1.73 m2), freedom from the primary outcome was significantly higher in the PVI + LVA-ABL group than in the PVI-alone group (69.1% vs. 43.3%; P = 0.004).

CONCLUSION

In patients with renal dysfunction, LVA ablation after PVI reduced AF recurrence after radiofrequency catheter ablation for persistent AF.

摘要

目的

SUPPRESS-AF试验表明，肺静脉隔离（PVI）加低电压区（LVA）消融可能会降低某些亚组的房颤（AF）复发率。肾功能不全是心房心肌病导致LVA的原因，也是导管消融术后AF复发的危险因素。本研究的目的是探讨按肾功能分层的PVI术后LVA消融的疗效。

方法与结果

本研究是对SUPPRESS-AF试验的亚分析，该试验是一项多中心、前瞻性、随机、开放标签试验。共分析了341例因持续性AF接受初次射频导管消融且LVA≥5 cm²的连续患者。患者被随机分为单纯PVI组（单纯PVI组）或PVI术后LVA消融组[PVI + LVA消融（ABL）组]。主要结局定义为消融后12个月内心房快速性心律失常的复发。在消融前评估估计肾小球滤过率（eGFR），并根据慢性肾脏病（CKD）分期对患者进行分层。平均eGFR为60±16 mL/min/1.73 m²，146例（43%）患者出现主要结局。在CKD G1-2（eGFR≥60 mL/min/1.73 m²）患者中，PVI + LVA-ABL组和单纯PVI组的主要结局无复发率相似（53.1%对55.3%，P = 0.59）。相比之下，在CKD G3a-5（eGFR < 60 mL/min/1.73 m²）患者中，PVI + LVA-ABL组的主要结局无复发率显著高于单纯PVI组（69.1%对43.3%；P = 0.004）。