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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Evaluation of linear lesions in the left and right atrium in ablation of long-standing atrial fibrillation
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Evaluation of linear lesions in the left and right atrium in ablation of long-standing atrial fibrillation

机译：长期房颤消融术中左右心房线性病变的评估

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Background This randomized prospective study compared three ablation strategies in patients with long-standing persistent atrial fibrillation (LPeAF). It also explored the best procedural endpoint from among the following: circumferential pulmonary vein isolation (PVI) + left atrial (LA) linear lesions (roofline, mitral isthmus) + complex fractionated atrial electrogram (CFAE) ablation, PVI + LA linear lesions + cavotricuspid isthmus (CTI) ablation + CFAE ablation, and PVI + CFAE ablation. Methods and Results A total of 210 patients with LPeAF referred for catheter ablation were enrolled and randomized into three ablation groups. The patients in group A (n = 70) underwent PVI followed by LA linear and CFAE ablation; in 93% of patients the primary endpoint was achieved (five patients with incomplete linear lesions). Of the 70 patients in group B who were subjected to PVI followed by LA linear, CFAE, and CTI ablations, in 94% of patients the primary endpoint was achieved (four patients with incomplete linear lesions). All patients in group C (n = 70) successfully underwent PVI and CFAE ablation. Direct current cardioversion was performed upon PVI, CFAE elimination, and completion of linear lesions. Patients were followed-up for atrial tachyarrhythmia recurrence for at least 24 months. After a single ablation procedure, group C (36%) exhibited the lowest success compared with group A (54%) and group B (51%) (P = 0.06). At the mean follow-up of 32 ± 9 months after the final ablation procedure, 53 patients (76%) in group A, 53 (76%) in group B, and 41 (59%) in group C were in sinus rhythm without antiarrhythmic drugs (P = 0.03). Conclusions In LPeAF, linear lesions in the LA help improve outcome of ablation, additional CTI ablation does not.
机译：背景这项随机前瞻性研究比较了长期持续性房颤（LPeAF）患者的三种消融策略。它还从以下方法中探索了最佳的手术终点：周围肺静脉隔离（PVI）+左心房（LA）线性病变（房顶，二尖瓣峡部）+复杂的心房电描记图（CFAE）消融，PVI + LA线性病变+左室窦突峡部（CTI）消融+ CFAE消融，以及PVI + CFAE消融。方法与结果共有210例接受导管消融的LPeAF患者入选，并随机分为三个消融组。 A组（n = 70）的患者行PVI，然后进行LA线性和CFAE消融。 93％的患者达到了主要终点指标（5名线性病变不完全的患者）。在B组的70例患者中，他们接受了PVI，然后进行了LA线性，CFAE和CTI消融，其中94％的患者达到了主要终点（4例线性病变不完全的患者）。 C组（n = 70）的所有患者均成功接受了PVI和CFAE消融术。在PVI，CFAE消除和线性病变完成后进行直流电复律。对患者进行房性心律失常复发的随访至少24个月。经过一次消融手术后，与A组（54％）和B组（51％）相比，C组（36％）的成功率最低（P = 0.06）。在最终消融手术后平均随访32±9个月时，A组53例（76％），B组53例（76％）和C组41例（59％）的窦性心律无抗心律失常药物（P = 0.03）。结论在LPeAF中，LA中的线性病变有助于改善消融效果，而其他CTI消融则不能。

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