冠状窦隔离治疗高负担心房颤动:随机临床试验

IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Clinical electrophysiology Pub Date : 2024-09-29 DOI:10.1016/j.jacep.2024.09.017
Jonathan P Ariyaratnam, Melissa E Middeldorp, Anthony G Brooks, Gijo Thomas, Kadhim Kadhim, Rajiv Mahajan, Rajeev K Pathak, Glenn D Young, Jonathan M Kalman, Prashanthan Sanders
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引用次数: 0

摘要

背景:冠状窦是一种心律失常的致病结构,可引发和维持心房颤动(房颤)。冠状窦消融术已被证明能有效延长阵发性和持续性房颤患者的房颤周期长度并终止房颤,这些患者在肺静脉隔离术(PVI)后仍有持续性房颤:本研究旨在开展一项随机对照试验,探讨冠状窦隔离术(CSI)作为辅助消融策略治疗高负担房颤的疗效:首次消融术的患者均为有症状的阵发性房颤长期发作(≥48小时但≤7天)或持续性房颤(>7天且≤12个月)转诊患者。参与者被随机分为 PVI、屋顶线消融和 CSI 组(CSI 组)或仅 PVI 和屋顶线消融组(非 CSI 组)。术后通过临床随访和 7 天 Holter 定期监测对参与者进行评估。主要结果是2年内无房性心律失常的单次手术无药物生存率:研究招募了 100 名参与者,其中 48 人被随机分配到 CSI 组,52 人被随机分配到非 CSI 组。CSI组的48名患者中有45人成功进行了CSI。在 2 年的随访中,CSI 组 48 名患者中有 30 名(62.5%)和非 CSI 组 52 名患者中有 33 名(63.4%)没有再发心律失常。各组 2 年的单次手术无药物生存率无差异(P = 0.91)。同样,多例手术药物辅助下的 5 年生存率在组间也无差异(P = 0.80)。各组间的并发症发生率无明显差异(P = 0.19):结论:在治疗高负担房颤时,作为从头消融策略一部分的辅助 CSI 不会带来比 PVI 和 roofline 更大的额外益处。
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Coronary Sinus Isolation for High-Burden Atrial Fibrillation: A Randomized Clinical Trial.

Background: The coronary sinus is an arrhythmogenic structure that can initiate and maintain atrial fibrillation (AF). Coronary sinus ablation has been shown to be effective in prolonging the AF cycle length and terminating AF in patients with both paroxysmal and persistent AF who have persistent AF after pulmonary vein isolation (PVI).

Objectives: The objective of this study was to undertake a randomized controlled trial to investigate the efficacy of coronary sinus isolation (CSI) as an adjunctive ablation strategy for the treatment of high-burden AF.

Methods: Consecutive patients presenting with symptomatic long episodes of paroxysmal AF (≥48 h but ≤7 days) or persistent AF (>7 days and ≤12 months) referred for first-time ablation were enrolled. Participants were randomized to either PVI, roofline ablation, and CSI (CSI group) or PVI and roofline ablation only (non-CSI group). Participants were assessed postprocedurally via clinical follow-up and 7-day Holter monitoring at regular intervals. The primary outcome was single-procedure drug-free atrial arrhythmia-free survival at 2 years.

Results: One hundred participants were recruited to the study; 48 were randomized to the CSI group and 52 to the non-CSI group. Acutely successful CSI was achieved in 45 of the 48 patients in the CSI group. At 2 years follow up, 30 of 48 patients (62.5%) in the CSI group and 33 of 52 (63.4%) in the non-CSI group were free from arrhythmia recurrence. Single-procedure drug-free survival at 2 years was no different between groups (P = 0.91). Similarly, multiple procedure drug assisted survival at 5 years was not different between groups (P = 0.80). Complication rates were not significantly different between groups (P = 0.19).

Conclusions: Adjunctive CSI as part of a de novo ablation strategy does not confer any additional benefit greater than PVI and roofline for the treatment of high-burden AF.

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来源期刊
JACC. Clinical electrophysiology
JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
5.70%
发文量
250
期刊介绍: JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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