持续心房的脉冲场移除与持续心电图监测 随访:ADVANTAGE AF-第2阶段
Vivek Y Reddy1, Edward P Gerstenfeld2, Boris Schmidt3
1Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, NY.
Circulation
|April 24, 2025
概括
对持续性心房动 (PerAF) 的脉冲场切除 (PFA) 是安全有效的肺静脉隔离 (PVI) 和后壁切除 (PWA). 随着持续的监测,Cavotricuspid峡谷 (CTI) 的切除也显示出良好的结果.
科学领域:
- 心脏病学
- 电生理学
- 医疗器械
背景情况:
- 对于持续性心房动 (PerAF),特别是肺静脉隔离以外的病变,脉冲场移除 (PFA) 的安全性和有效性数据有限.
- 没有大型试验使用可插入的心脏监测器 (ICM) 来对PFA患者或任何心房动患者进行持续的节律监测.
- 在ADVANTAGE AF第2期研究中,对PVA和后壁切除 (PWA) 的PFA进行了研究,其中一小队接受了洞腔沟切除 (CTI) 切除.
研究的目的:
- 评估PFA在PVA患者中的安全性和有效性.
- 在一组PerAF患者中评估PFA的安全性和有效性.
- 使用ICM检查心房失常 (AA) 负担和发作持续时间,以持续监测心律.
主要方法:
- 患者接受PVA和PWA使用PFA管,并使用PFA焦线管进行CTI切除,并进行静脉注射甘 (NTG) 预防.
- 用ICM持续监测患者1年,以评估初级疗效终点并分析AA负担和发作持续时间.
- 这项研究旨在模拟主要终点的传统间歇性监测,同时检查详细的节律数据.
主要成果:
- 这项研究包括255名PerAF患者;PVI和PWA分别获得了99. 6%和100%的急性成功. 在141名患者 (55. 3%) 进行了CTI PFA,达到98. 6%的双向阻塞无并发症.
- 使用传统的监测模拟,无AA为73. 4%,不良事件为2. 4%. 没有复发性心房的病例为97. 2%.
- 连续ICM数据显示52. 0%的患者没有AA≥30秒,其中94. 0%的发作不超过24小时. 一个AA负担>0.1%或最长的发作持续时间>1小时预测了医疗利用率的增加. 根据这些值,一年的程序有效率为71.6%和70.0%.
结论:
- 在ADVANTAGE AF第二期研究中,使用NTG预防的CTI切除是安全有效的.
- 使用PFA的PVI+PWA在PerAF患者中也被证明是安全和有效的.
- 与最低医疗利用率相关的终点是AA负担<0. 1%和AA事件持续时间<1小时.
相关概念视频
Pulse rhythm
717
Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
717
Electrocardiogram
1.6K
An electrocardiogram (ECG or EKG) is a critical diagnostic tool that records the electrical signals produced by the heart during each heartbeat. This recording is achieved through electrodes placed strategically on the arms, legs, and chest. The electrocardiograph amplifies these signals and produces 12 distinct tracings, offering a comprehensive understanding of the heart's electrical activity.
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
1.6K
Disturbances in Heart Rhythm
710
Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
710


