Heart rhythm · 2012
Improved outcome following restoration of sinus rhythm prior to catheter ablation of persistent atrial fibrillation: a comparative multicenter study.
Сравнительное исследованиеСтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Rivard Léna, Hocini Mélèze, Rostock Thomas, Cauchemez Bruno, Forclaz Andrei, Jadidi Amir S, Linton Nick, Nault Isabelle, Miyazaki Shinsuke, Liu Xingpeng, Xhaet Olivier, Shah Ashok, Sacher Frédéric, Derval Nicolas, Jaïs Pierre, Khairy Paul, Macle Laurent, Nattel Stanley, Willems Stephan, Haïssaguerre Michel
Аннотация
BACKGROUND: Catheter ablation of persistent atrial fibrillation (AF) is associated with longer procedure times and lower long-term success rates than that of paroxysmal AF.
OBJECTIVE: To test the hypothesis that restoration/maintenance of sinus rhythm (SR) preablation would facilitate AF termination and improve outcomes in patients with persistent AF.
METHODS: We conducted a 2-group cohort study of consecutive patients with persistent AF and SR restored for at least 1 month prior to ablation (SR group; n = 40) and controls matched by age, sex, and AF duration (control group; n = 40). Radiofrequency stepwise catheter ablation was performed in AF for both groups (induced and spontaneous, respectively). Success was defined as freedom from atrial tachyarrhythmia without antiarrhythmic drugs beyond 1 year of follow-up.
RESULTS: During the index ablation procedure, AF cycle length was longer in the SR group than in the control group (183 ± 32 ms vs 166 ± 20 ms; P = .06), suggestive of reverse remodeling. In the SR group, AF more frequently terminated during ablation (95.0% vs 77.5%; P <.05) and required less extensive ablation of complex fractionated electrograms (40.0% vs 87.5%; P <.001) and linear lesions (42.5% vs 82.5%; P <.001). Mean procedural (199.8 ± 69.8 minutes vs 283.5 ± 72.3 minutes; P <.001), fluoroscopy (51.0 ± 24.9 minutes vs 96.3 ± 32.1 minutes; P <.001), and radiofrequency energy delivery (47.5 ± 18.9 minutes vs 97.0 ± 30.6 minutes; P <.001) times were shorter in the SR group. Clinical success rates were similar between groups for first (55.0% vs 45.0%; P = .28) and last (80.0% vs 70.0%; P = .28) procedures, during similar follow-up periods (21.1 ± 9.7 months).
CONCLUSIONS: Restoration of SR prior to catheter ablation for persistent AF whenever possible decreases the extent of ablation with the same high clinical efficacy.
OBJECTIVE: To test the hypothesis that restoration/maintenance of sinus rhythm (SR) preablation would facilitate AF termination and improve outcomes in patients with persistent AF.
METHODS: We conducted a 2-group cohort study of consecutive patients with persistent AF and SR restored for at least 1 month prior to ablation (SR group; n = 40) and controls matched by age, sex, and AF duration (control group; n = 40). Radiofrequency stepwise catheter ablation was performed in AF for both groups (induced and spontaneous, respectively). Success was defined as freedom from atrial tachyarrhythmia without antiarrhythmic drugs beyond 1 year of follow-up.
RESULTS: During the index ablation procedure, AF cycle length was longer in the SR group than in the control group (183 ± 32 ms vs 166 ± 20 ms; P = .06), suggestive of reverse remodeling. In the SR group, AF more frequently terminated during ablation (95.0% vs 77.5%; P <.05) and required less extensive ablation of complex fractionated electrograms (40.0% vs 87.5%; P <.001) and linear lesions (42.5% vs 82.5%; P <.001). Mean procedural (199.8 ± 69.8 minutes vs 283.5 ± 72.3 minutes; P <.001), fluoroscopy (51.0 ± 24.9 minutes vs 96.3 ± 32.1 minutes; P <.001), and radiofrequency energy delivery (47.5 ± 18.9 minutes vs 97.0 ± 30.6 minutes; P <.001) times were shorter in the SR group. Clinical success rates were similar between groups for first (55.0% vs 45.0%; P = .28) and last (80.0% vs 70.0%; P = .28) procedures, during similar follow-up periods (21.1 ± 9.7 months).
CONCLUSIONS: Restoration of SR prior to catheter ablation for persistent AF whenever possible decreases the extent of ablation with the same high clinical efficacy.