Ablation Strategies for Repeat Procedures in Atrial Fibrillation Recurrences Despite Durable Pulmonary Vein Isolation: The Prospective Randomized ASTRO AF Multicenter Trial.

IF 5.2 3区工程技术 Q2 ENERGY & FUELS Energy & Fuels Pub Date : 2024-10-07 DOI:10.1161/CIRCULATIONAHA.124.069993

Boris Schmidt, Stefano Bordignon, Andreas Metzner, Philipp Sommer, Daniel Steven, Tilmann Dahme, Matthias Busch, Roland Richard Tilz, David Schaack, Andreas Rillig, Christian Sohns, Arian Sultan, Karolina Weinmann-Emhardt, Astrid Hummel, Julia Vogler, Thomas Fink, Jakob Lueker, Alexander Pott, Christian Heeger, K-R Julian Chun

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Abstract

Background: Ablation strategies for patients with symptomatic atrial fibrillation and isolated pulmonary veins vary and their effects on arrhythmia recurrence remain unclear. A prospective randomized German multicenter trial sought to compare 2 ablation strategies in this patient cohort.

Methods: Patients with atrial fibrillation despite durable pulmonary vein isolation were randomly assigned at 7 centers to undergo low-voltage area ablation using 3-dimensional mapping and irrigated radiofrequency current ablation (group A) or empirical left atrial appendage isolation (LAAI) using the cryoballoon followed by staged interventional left atrial appendage closure (group B). The primary end point was freedom from atrial tachyarrhythmias between 91 and 365 days after index ablation. The study was powered for superiority of LAAI compared with low-voltage area.

Results: Patients (40% women; mean age, 68.8±8 years) with paroxysmal (32%) or persistent atrial fibrillation (68%) were randomized to undergo low-voltage area ablation (n=79) or cryoballoon-guided LAAI (n=82). After a planned interim analysis, enrollment was halted for futility on January 10, 2023. In the LAAI group, 77 of 82 left atrial appendages were successfully isolated with subsequent left atrial appendage closure in 57 patients. Procedure-related complications occurred in 4 (5%) and 11 (13.5%) patients in group A and B, respectively (P=0.10). The median follow-up was 367 days (interquartile range, 359-378). The Kaplan-Meier point estimate for freedom from atrial tachyarrhythmias was 51.7% (CI, 40.9%-65.4%) for group A and 55.5% (CI, 44.4%-69.2%; P=0.8069) for group B.

Conclusions: The current study did not detect superiority of cryoballoon-guided LAAI over low-voltage area ablation in patients with atrial fibrillation despite durable PVI.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04056390.

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尽管进行了持久的肺静脉隔离，心房颤动复发时重复手术的消融策略：前瞻性随机 ASTRO 心房颤动多中心试验。

背景：针对症状性心房颤动和孤立性肺静脉患者的消融策略各不相同，它们对心律失常复发的影响仍不明确。一项前瞻性的德国多中心随机试验试图对这一患者群体中的两种消融策略进行比较：方法：在 7 个中心随机分配肺静脉持久隔离后仍有心房颤动的患者，使用三维映射和灌注射频电流进行低电压区域消融（A 组），或使用冷冻球囊进行经验性左房阑尾隔离 (LAI)，然后分阶段进行介入性左房阑尾关闭术（B 组）。主要终点是指数消融术后 91 天至 365 天内无房性快速性心律失常。研究结果显示，LAAI优于低电压区：阵发性心房颤动（32%）或持续性心房颤动（68%）患者（40%为女性；平均年龄（68.8±8）岁）随机接受低电压区消融术（79人）或冷冻球囊引导下的LAI（82人）。经过计划的中期分析后，2023 年 1 月 10 日因无效而停止入组。在 LAAI 组中，82 名患者中有 77 名成功隔离了左心房阑尾，57 名患者随后关闭了左心房阑尾。A 组和 B 组分别有 4 例（5%）和 11 例（13.5%）患者出现手术相关并发症（P=0.10）。中位随访天数为 367 天（四分位间范围为 359-378 天）。A组患者摆脱房性快速性心律失常的Kaplan-Meier点估计值为51.7%（CI，40.9%-65.4%），B组为55.5%（CI，44.4%-69.2%；P=0.8069）：目前的研究并未发现低温球囊引导下的 LAAI 优于低电压区消融术，尽管低电压区消融术对心房颤动患者具有持久的 PVI.Registration：URL：https://www.clinicaltrials.gov；唯一标识符：NCT04056390。

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来源期刊

Energy & Fuels 工程技术-工程：化工

CiteScore

9.20

自引率

13.20%

发文量

1101

审稿时长

2.1 months

期刊介绍： Energy & Fuels publishes reports of research in the technical area defined by the intersection of the disciplines of chemistry and chemical engineering and the application domain of non-nuclear energy and fuels. This includes research directed at the formation of, exploration for, and production of fossil fuels and biomass; the properties and structure or molecular composition of both raw fuels and refined products; the chemistry involved in the processing and utilization of fuels; fuel cells and their applications; and the analytical and instrumental techniques used in investigations of the foregoing areas.