初始扩展性切除在重复手术期间对左心房间隙的影响以及持续性心房的后续结果
Masato Okada1, Koichi Inoue1,2, Nobuaki Tanaka1
1Cardiovascular Center, Sakurabashi Watanabe Advanced Healthcare Hospital, Osaka, Japan (M.O., K.I., N.T., K.T., Y.H.).
Circulation. Arrhythmia and electrophysiology
|June 2, 2025
概括
针对持续性心房动 (AF) 的广泛线性切除可能会增加导电间隙. 重复切除后的肺静脉 (PV) 间隙与复发有关,与线性病变中的间隙不同.
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:
- 持续性心房动 (AF) 的消化疗效受到争议,特别是在肺静脉 (PV) 隔离之外的广泛线性策略方面.
- 除病变中的导电缺口可以引发心律失常并降低治疗的有效性.
- 这项研究调查了在EARNEST-PVI试验中进行重复切除的持续性AF患者的缺口和复发情况.
研究的目的:
- 为了评估在重复AF切除过程中左心房导电缺口的发生率.
- 为了确定与间隙相关的重新进入和随后的心律失常复发的发生.
- 为了比较肺静脉隔离 (PVI) 单独重复和PVI加线性重复策略之间的结果.
主要方法:
- 来自EARNEST-PVI试验的115名患者的分析,这些患者接受了重复AF切除 (单独PVI与PVI加线性).
- 评估左心房传导间隙,包括PV间隙和线性间隙.
- 两种重复策略之间的心房高心率发生率和复发率的比较.
主要成果:
- 在PVI加线性重复组 (41-57%) 与PVI单独重复组 (38%) 相比,左心房导电缺口更频繁.
- 在PVI加组 (23.9%) 中,心房动脉冲动明显比PVI单独组 (5.8%) 更常见.
- 线性病变的差距与心房高心率相关,而单独的PV差距预测了重复切除后的复发 (HR 0.54).
结论:
- 在 EARNEST-PVI 试验中,Redo AF 除显示了先前广泛的线性除时更高的导电间隙.
- 虽然所有缺口都可能引起心律失常,但肺静脉缺口特别与复发后的复发有关.
- 结果表明,在持续的AF管理中,对线性废除策略的细微方法.
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