用优化线性切除隔离肺静脉与单独隔离肺静脉治疗持久性肌痛:PROMPT-AF随机临床试验
Caihua Sang1, Qiang Liu2, Yiwei Lai1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
JAMA
|November 18, 2024
概括
与单独使用PVI相比,增加马歇尔静脉 (EIVOM) 乙醇输液和线性切除肺静脉隔离 (PVI) 显著改善了持续性心房动 (AF) 患者的鼻腔节律维持.
科学领域:
- 心脏病学
- 电生理学
- 医疗干预
背景情况:
- 肺静脉隔离 (PVI) 对持续性心房 (AF) 的成功率很低.
- 之前的随机试验没有显示出超越PVI的额外线性切除的优势.
- 马歇尔静脉 (EIVOM) 的乙醇输液可以通过促进心肌断层切除来增强线性切除策略.
研究的目的:
- 评估与EIVOM和PVI相结合的线性切除与单独PVI相比,在持久性AF患者中改善了鼻腔节律的维持.
- 评估包括EIVOM和线性除在内的强化除策略对持久性AF的有效性.
- 确定EIVOM辅助线性切除对AF患者长期节律控制的影响.
主要方法:
- 一个多中心的随机试验 (PROMPT- AF) 涉及498名持久性AF患者进行首次切除.
- 患者被随机分配到单独进行PVI或PVI加EIVOM和线性切除 (左心室顶部,心室峡,腔峡).
- 通过心电图贴片和霍尔特监测,在12个月内没有心脏节律失常 (> 30秒) 没有抗心律失常药物.
主要成果:
- 在12个月后,PVI加EIVOM和线性切除组中的70. 7%的患者没有心房失常,而PVI单独组的61. 5% (HR 0. 73;P=0. 045) 没有心脏失常.
- 这项干预措施在预先指定的子组中显示出一致的效果.
- 两组之间的二次结果没有显著差异.
结论:
- 线性切除与EIVOM和PVI相结合,在持续的AF患者中显著改善了心房律乱.
- 这种增强的切除策略比单独使用PVI对治疗持久性肌痛有潜在的改善.
- 这项研究证实了EIVOM在促进AF治疗中更有效的线性切除效果.
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