Targeting non-pulmonary vein triggers in persistent atrial fibrillation: results from a prospective, multicentre, observational registry

被引:53
作者
Della Rocca, Domenico G. [1 ]
Di Biase, Luigi [1 ,2 ,3 ,4 ,5 ]
Mohanty, Sanghamitra [1 ]
Trivedi, Chintan [1 ]
Gianni, Carola [1 ]
Romero, Jorge [4 ]
Tarantino, Nicola [4 ]
Magnocavallo, Michele [6 ]
Bassiouny, Mohamed [1 ]
Natale, Veronica N. [7 ]
Mayedo, Angel Quintero [1 ]
Macdonald, Bryan [1 ]
Lavalle, Carlo [6 ]
Murtaza, Ghulam [8 ]
Akella, Krishna [8 ]
Forleo, Giovanni B. [9 ]
Al-Ahmad, Amin [1 ]
Burkhardt, John David [1 ]
Gallinghouse, Gerald Joseph [1 ]
Sanchez, Javier E. [1 ]
Horton, Rodney P. [1 ]
Viles-Gonzalez, Juan F. [10 ]
Lakkireddy, Dhanunjaya [9 ]
Natale, Andrea [1 ,2 ,3 ,11 ,12 ,13 ]
机构
[1] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, 3000 N IH 35, Austin, TX 78705 USA
[2] Univ Texas Austin, Dell Med Sch, Dept Internal Med, Austin, TX 78712 USA
[3] Univ Texas Austin, Cockrell Sch Engn, Dept Biomed Engn, Austin, TX 78712 USA
[4] Albert Einstein Coll Med, Montefiore Med Ctr, Dept Med, Arrhythmia Serv, Bronx, NY 10467 USA
[5] Univ Foggia, Dept Clin & Expt Med, Foggia, Italy
[6] Sapienza Univ Rome, Dept Cardiovasc Resp Nephrol Anesthesiol & Geriat, Viale Policlin 155, I-00161 Rome, Italy
[7] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA
[8] Kansas Univ Hosp, Cardiovasc Res Inst, Kansas City, KS USA
[9] Luigi Sacco Hosp, Dept Cardiol, Milan, Italy
[10] Baptist Hlth, Miami Cardiovasc Inst, Miami, FL USA
[11] Scripps Clin, Intervent Electrophysiolov, La Jolla, CA USA
[12] Case Western Reserve Univ, Sch Med, MetroHlth Med Ctr, Dept Cardiol, Cleveland, OH 44106 USA
[13] Stanford Univ, Div Cardiol, Stanford, CA 94305 USA
来源
EUROPACE | 2021年 / 23卷 / 12期
关键词
Pulmonary veins; Persistent atrial fibrillation; Catheter ablation; Non-pulmonary vein triggers; Outcomes; Registry; CATHETER ABLATION;
D O I
10.1093/europace/euab161
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims We evaluated the efficacy of an ablation strategy empirically targeting pulmonary veins (PVs) and posterior wall (PW) and the prevalence and clinical impact of extrapulmonary trigger inducibility and ablation in a large cohort of patients with persistent atrial fibrillation (PerAF). Methods and Results A total of 1803 PerAF patients were prospectively enrolled. All patients underwent pulmonary vein antrum isolation (PVAI) extended to the entire PW. A standardized protocol was performed to confirm persistent PVAI and elicit any triggers originating from non-PV sites. All non-PV triggers initiating sustained atrial tachyarrhythmias were ablated. Ablation of non-PV sites triggering non-sustained runs (<30 s) of atrial tachyarrhythmias or promoting frequent premature atrial complexes (>= 10/min) was left to operator's discretion. Overall, 1319 (73.2%) patients had documented triggers from non-PV areas. After 17.4 +/- 8.5 months of follow-up, the cumulative freedom from atrial tachyarrhythmias among patients without inducible non-PV triggers (n = 484) was 70.2%. Patients with ablation of induced non-PV triggers had a significantly higher arrhythmia control than those whose triggers were not ablated (67.9% vs. 39.4%, respectively; P < 0.001). After adjusting for clinically relevant variables, patients in whom non-PV triggers were documented but not ablated had an increased risk of arrhythmia relapse (hazard ratio: 2.39; 95% confidence interval: 2.01-2.83; P< 0.001). Conclusion Pulmonary vein antrum isolation extended to the entire PW might provide acceptable long-term arrhythmia-free survival in PerAF patients without inducible non-PV triggers. In our population of PerAF patients, non-PV triggers could be elicited in similar to 70% of PerAF patients and their elimination significantly improved outcomes.
引用
收藏
页码:1939 / 1949
页数:11
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