后左心房电压对持续心房的废除结果的影响:CAPLA子研究
David Chieng1, Hariharan Sugumar1, Andrew Hunt2
1The Baker Heart and Diabetes Research Institute, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Cabrini Hospital, Melbourne, Australia.
JACC. Clinical electrophysiology
|September 16, 2023
概括
肺静脉隔离 (PVI) 对持续性心房动 (PsAF) 不太有效. 将后壁隔离 (PWI) 添加到PVI中没有改善低电压区域 (LVAs) 的PsAF患者的结果.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 医疗器械 医疗器械
背景情况:
- 肺静脉隔离 (PVI) 是对心房的标准治疗方法,但在持久病例 (PsAF) 中显示出有限的疗效.
- 前庭的低电压区域 (LVAs) 与切除后心律失常复发的增加有关.
- 通过辅助除策略向LVAs可能会提高PsAF患者的手术成功率.
研究的目的:
- 为了比较PVI与后壁隔离 (PWI) 结合的PVI与PVI单独的有效性,在患有后壁LVAs的PsAF患者中.
- 为了评估PWI对心房失常症在12个月后复发的影响.
主要方法:
- CAPLA研究是一项多中心的随机试验,比较PVA单独与PVA与PWI在PsAF患者中.
- 包括后部LVAs (双极电压<0.5mV) 的患者.
- 主要终点是12个月后不出现心房律乱症复发,并停止服用抗心律乱症药物.
主要成果:
- 后部LVA存在于32.9%的患者中,并与更高的心律失常复发风险相关 (56.5%与41.4%相比).
- 后部LVA患者的左心脏直径也更大,其他区域的LVA更频繁.
- 与单独使用PVI相比,将PWI添加到PVI中并没有显著降低心房律乱复发率 (44.8%对41.9%).
结论:
- 后部LVA是经过导管切除的PsAF患者中心房律乱复发的显著预测因素.
- 将PWI添加到PVI中并没有改善后部LVAs的PsAF患者的结果.
- 可能需要进一步的研究来确定对具有复杂电生理基质的PsAF患者的最佳废弃策略.
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