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One-year outcomes after pulmonary vein isolation plus posterior wall isolation and additional non-pulmonary vein trigger ablation for persistent atrial fibrillation with or without contact force sensing: a propensity score-matched comparison.

肺静脉隔离加后壁隔离和附加非肺静脉触发消融治疗持续性房颤伴或不伴接触力感知后的 1 年结局: 倾向评分匹配比较。

  • 影响因子:1.65
  • DOI:10.1007/s10840-019-00700-1
  • 作者列表:"Takamiya T","Nitta J","Inaba O","Sato A","Ikenouchi T","Murata K","Inamura Y","Takahashi Y","Goya M","Hirao K
  • 发表时间:2020-01-06
Abstract

PURPOSE:Whether or not pulmonary vein isolation (PVI) plus left atrial posterior wall isolation (PWI) using contact force (CF) sensing improves the ablation outcome for persistent atrial fibrillation (AF) is unclear. This study compared the outcome of PVI plus PWI and additional non-PV trigger ablation for persistent AF with/without CF sensing. METHODS:This retrospective cohort study analyzed 148 propensity score-matched persistent AF patients (median duration of persistent AF, 8 months (interquartile range, 3-24 months); left atrial diameter, 43 ± 7 mm) undergoing PVI plus PWI and ablation of non-PV triggers provoked by high-dose isoproterenol, including 74 with CF-sensing catheters (CF group) and 74 with conventional catheters (non-CF group). PVI plus PWI with no additional ablation but cavotricuspid isthmus ablation was performed without non-PV triggers in 48 CF patients (65%) and 54 non-CF patients (73%) (P = 0.38). In all other patients, we performed additional ablation of provoked non-PV triggers. RESULTS:The Kaplan-Meier estimate of the rate of freedom from atrial tachyarrhythmia recurrence of antiarrhythmic drugs at 12 months after the single procedure was higher in the CF group than in the non-CF group (85 vs. 70%, log-rank P = 0.030). A multivariable analysis revealed that using CF sensing and non-inducibility of AF from a non-PV trigger after PVI and PWI were significantly associated with a reduced rate of atrial tachyarrhythmia recurrence. CONCLUSIONS:Compared with non-CF sensing, PVI plus PWI and additional non-PV trigger ablation using CF-sensing catheters for persistent AF can reduce the rate of atrial tachyarrhythmia recurrence.

摘要

目的: 使用接触力 (CF) 传感的肺静脉隔离 (PVI) 加左房后壁隔离 (PWI) 是否改善持续性房颤 (AF) 的消融结果不清楚。本研究比较了 PVI 加 PWI 和附加非 PV 触发消融治疗持续性 AF 伴/不伴 CF 感应的结局。 方法: 这项回顾性队列研究分析了 148 例倾向评分匹配的持续性房颤患者 (持续性房颤的中位持续时间,8 个月 (四分位距,3-24 个月); 左心房直径, 43 ± 7毫米) 接受 PVI 加 PWI 和大剂量异丙肾上腺素激发的非 PV 触发物消融,包括 74 例使用 CF 传感导管 (CF 组)和 74 用常规导管 (非 CF 组)。在 48 例 CF 患者 (65%) 和 54 例非 CF 患者 (73%) 中进行了 PVI 加 PWI,没有额外的消融,但进行了三尖瓣峡部消融,没有非 PV 触发。 (p = 0.38)。在所有其他患者中,我们对激发的非 PV 触发器进行了额外的消融。 结果: 单药术后 12 个月抗心律失常药物的房性快速性心律失常复发率的 Kaplan-Meier 估计值 CF 组高于非 CF 组 (85 vs。70%,log-rank p = 0.030)。多变量分析显示,使用 CF 感测和 PVI 和 PWI 后非 PV 触发的 AF 非诱导性与房性心律失常复发率降低显著相关。 结论: 与非 CF 传感相比,PVI 加 PWI 和额外的非 PV 触发消融使用 CF 传感导管治疗持续性 AF 可降低房性快速性心律失常复发率。

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DOI:10.1093/europace/euz244
作者列表:["Berte B","Hilfiker G","Moccetti F","Schefer T","Weberndörfer V","Cuculi F","Toggweiler S","Ruschitzka F","Kobza R"]

METHODS:AIMS:Pulmonary vein isolation (PVI) using ablation index (AI) incorporates stability, contact force (CF), time, and power. The CLOSE protocol combines AI and ≤6 mm interlesion distance. Safety concerns are raised about surround flow ablation catheters (STSF). To compare safety and effectiveness of an atrial fibrillation (AF) ablation strategy using AI vs. CLOSE protocol using STSF.,METHODS AND RESULTS:First cluster was treated using AI and second cluster using CLOSE. Procedural data, safety, and recurrence of any atrial tachycardia (AT) or AF >30 s were collected prospectively. All Classes 1c and III anti-arrhythmic drugs (AAD) were stopped after the blanking period. In total, all 215 consecutive patients [AI: 121 (paroxysmal: n = 97), CLOSE: n = 94 (paroxysmal: n = 74)] were included. Pulmonary vein isolation was reached in all in similar procedure duration (CLOSE: 107 ± 25 vs. AI: 102 ± 24 min; P = 0.1) and similar radiofrequency time (CLOSE: 36 ± 11 vs. AI: 37 ± 8 min; P = 0.4) but first pass isolation was higher in CLOSE vs. AI [left veins: 90% vs. 80%; P < 0.05 and right veins: 84% vs. 73%; P < 0.05]. Twelve-month off-AAD freedom of AF/AT was higher in CLOSE vs. AI [79% (paroxysmal: 85%) vs. 64% (paroxysmal: 68%); P < 0.05]. Only four patients (2%) without recurrence were on AAD during follow-up. Major complications were similar (CLOSE: 2.1% vs. AI: 2.5%; P = 0.87).,CONCLUSION:The CLOSE protocol is more effective than a PVI approach solely using AI, especially in paroxysmal AF. In this off-AAD study, 79% of patients were free from AF/AT during 12-month follow-up. The STSF catheter appears to be safe using conventional CLOSE targets.

翻译标题与摘要 下载文献
影响因子:2.45
发表时间:2020-01-01
DOI:10.1111/jce.14268
作者列表:["Qin M","Jiang WF","Wu SH","Xu K","Liu X"]

METHODS:OBJECTIVE:To investigate the role of driver mechanism and the effect of electrogram dispersion-guided driver mapping and ablation in atrial fibrillation (AF) at different stages of progression.,METHODS:A total of 256 consecutive patients with AF who had undergone pulmonary vein isolation (PVI) plus driver ablation or conventional ablation were divided into three groups: paroxysmal atrial fibrillation (PAF; group A, n = 51); persistent atrial fibrillation (PsAF; group B, n = 38); and long standing-persistent atrial fibrillation (LS-PsAF; group C, n = 39). PVI was performed with the guidance of the ablation index. The electrogram dispersion was analyzed for driver mapping.,RESULTS:The most prominent driver regions were at roof (28.0%), posterior wall (17.6%), and bottom (21.3%). From patients with PAF to those with PsAF and LS-PsAF: the complexity of extra-pulmonary vein (PV) drivers including distribution, mean number, and area of dispersion region increased (P < .001). Patients who underwent driver ablation vs conventional ablation had higher procedural AF termination rate (76.6% vs 28.1%; P < .001). With AF progression, the termination rate gradually decreased from group A to group C, and the role of PVI in AF termination was also gradually weakened from group A to group C (39.6%, 7.4%, and 4.3%; P < .001) in patients with driver ablation. At the end of the follow-up, the rate of sinus rhythm maintenance was higher in patients with driver ablation than those with conventional ablation (89.1% vs 70.3%; P < .001).,CONCLUSION:The formation of extra-PV drivers provides an important mechanism for AF maintenance with their complexity increasing with AF progression. Electrogram dispersion-guided driver ablation appears to be an efficient adjunctive approach to PVI for AF treatment.

翻译标题与摘要 下载文献
影响因子:1.65
发表时间:2020-01-06
DOI:10.1007/s10840-019-00700-1
作者列表:["Takamiya T","Nitta J","Inaba O","Sato A","Ikenouchi T","Murata K","Inamura Y","Takahashi Y","Goya M","Hirao K"]

METHODS:PURPOSE:Whether or not pulmonary vein isolation (PVI) plus left atrial posterior wall isolation (PWI) using contact force (CF) sensing improves the ablation outcome for persistent atrial fibrillation (AF) is unclear. This study compared the outcome of PVI plus PWI and additional non-PV trigger ablation for persistent AF with/without CF sensing. METHODS:This retrospective cohort study analyzed 148 propensity score-matched persistent AF patients (median duration of persistent AF, 8 months (interquartile range, 3-24 months); left atrial diameter, 43 ± 7 mm) undergoing PVI plus PWI and ablation of non-PV triggers provoked by high-dose isoproterenol, including 74 with CF-sensing catheters (CF group) and 74 with conventional catheters (non-CF group). PVI plus PWI with no additional ablation but cavotricuspid isthmus ablation was performed without non-PV triggers in 48 CF patients (65%) and 54 non-CF patients (73%) (P = 0.38). In all other patients, we performed additional ablation of provoked non-PV triggers. RESULTS:The Kaplan-Meier estimate of the rate of freedom from atrial tachyarrhythmia recurrence of antiarrhythmic drugs at 12 months after the single procedure was higher in the CF group than in the non-CF group (85 vs. 70%, log-rank P = 0.030). A multivariable analysis revealed that using CF sensing and non-inducibility of AF from a non-PV trigger after PVI and PWI were significantly associated with a reduced rate of atrial tachyarrhythmia recurrence. CONCLUSIONS:Compared with non-CF sensing, PVI plus PWI and additional non-PV trigger ablation using CF-sensing catheters for persistent AF can reduce the rate of atrial tachyarrhythmia recurrence.

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