Direct-to-catheter ablation versus second line catheter ablation for persistent atrial fibrillation: Effect on arrhythmia recurrence, AF burden, early left atrium remodeling and quality of life

IF 2.1 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Interventional Cardiac Electrophysiology Pub Date : 2024-09-12 DOI:10.1007/s10840-024-01916-6

Hadi Younes, Besim Ademi, Eli Tsakiris, Han Feng, Amitabh C. Pandey, Mario Mekhael, Charbel Noujaim, Chanho Lim, Lilas Dagher, Abdel Hadi El Hajjar, Ghassan Bidaoui, Mayana Bsoul, Ala Assaf, Swati Rao, Christian Mahnkopf, Ghaith Shamaileh, Omar Kreidieh, Abboud Hassan, Yinshuo Liu, Yishi Jia, Francisco T. Polo, Nassir F. Marrouche, Eoin Donnellan

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Abstract

Background

Catheter ablation has obtained class 1 indication in ablation of young, healthy patients with symptomatic paroxysmal atrial fibrillation (AF). Anti-arrhythmic drugs (AADs) remain first-line therapy before ablating persistent AF (PersAF). We sought to evaluate the efficacy of a direct-to-catheter ablation approach against catheter ablation post AADs in PersAF.

Methods

In this DECAAF II subanalysis, patients were stratified into two subgroups: ‘Direct-to-catheter’ group comprising patients who had not received AADs prior to ablation, and’second-line ablation’ group, comprising patients who had been on any AAD therapy at any time before ablation. Patients were followed over 18 months. The primary outcome was AF recurrence. Secondary outcomes included AF burden, quality of life (QoL) that assessed by the AFSS and SF-36 scores, and changes in the left atrial volume index (LAVI) assessed by LGE-MRI scans.

Results

The analysis included 815 patients, with 279 classified as’direct-to-catheter’ group and 536 classified as’Second-line ablation’ group. The primary outcome was similar between both groups (44.8% vs 44.4%, p > 0.05), as was AF burden (20% vs 16%, p > 0.05). Early remodeling, reflected by LAVI reduction, was similar between the groups (9.1 [1.6—18.0] in the second-line ablation group and 9.5 [2.5—19.7] in the direct-to-catheter group, p > 0.05). QoL pre/post ablation was also similar (p > 0.05). On multivariate analysis, history of AAD was not predictive of AF recurrence(p > 0.05).

Conclusion

Prior AAD therapy demonstrated minimal impact on atrial remodeling and QoL improvement, in addition to limited benefit on AF recurrence and burden post-ablation in patients with PersAF. Additional studies are warranted to explore the efficacy of catheter ablation as a first-line therapy in PersAF.

Graphical Abstract

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直接导管消融与二线导管消融治疗持续性心房颤动：对心律失常复发、房颤负担、早期左心房重塑和生活质量的影响

背景导管消融术已获得一级适应症，适用于有症状的阵发性房颤（AF）年轻健康患者的消融治疗。在消融持续性房颤（PersAF）之前，抗心律失常药物（AADs）仍是一线疗法。在这项 DECAAF II 子分析中，患者被分为两个亚组："直接导管 "组，包括消融前未接受过 AADs 治疗的患者；"二线消融 "组，包括消融前任何时候接受过任何 AADs 治疗的患者。对患者进行了 18 个月的随访。主要结果是房颤复发。次要结果包括房颤负担、通过AFSS和SF-36评分评估的生活质量（QoL），以及通过LGE-MRI扫描评估的左心房容积指数（LAVI）变化。两组的主要结果相似（44.8% vs 44.4%，p > 0.05），房颤负荷也相似（20% vs 16%，p > 0.05）。通过 LAVI 降低反映的早期重塑情况在两组之间相似（二线消融组为 9.1 [1.6-18.0] 次，直接导管组为 9.5 [2.5-19.7] 次，p > 0.05）。消融前后的 QoL 也相似（p > 0.05）。结论先前的 AAD 治疗对心房重塑和 QoL 改善的影响微乎其微，此外对持续房颤患者消融术后房颤复发和负担的益处有限。有必要开展更多研究，探讨导管消融作为 PersAF 一线疗法的疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Interventional Cardiac Electrophysiology 医学-心血管系统

CiteScore

4.30

自引率

11.10%

发文量

320

审稿时长

4-8 weeks

期刊介绍： The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.