医学
肺静脉
心房颤动
射频消融术
心脏病学
无症状的
内科学
烧蚀
导管消融
随机对照试验
外科
作者
Adam C. Lee,A. Voskoboinik,CL Cheung,Sarah Yogi,Zian H. Tseng,Joshua D. Moss,Thomas A. Dewland,Byron K. Lee,Randall J. Lee,Henry H. Hsia,Gregory M Marcus,Vasanth Vedantham,David Chieng,P. Kistler,William P. Dillon,Eric Vittinghoff,Edward P. Gerstenfeld
标识
DOI:10.1016/j.jacep.2022.12.020
摘要
High-power, short duration (HPSD) radiofrequency ablation (RFA) is a commonly used strategy for pulmonary vein isolation (PVI). This study sought to compare HPSD with standard power, standard duration (SPSD) RFA in patients undergoing PVI. Patients with paroxysmal or persistent (<1 year) atrial fibrillation (AF) were randomized to HPSD (50 W) or SPSD (25-30 W) RFA to achieve PVI. Outcomes assessed included time to achieve PVI (primary), left atrial dwell time, total procedure time, first-pass isolation, PV reconnection with adenosine, procedure complications including asymptomatic cerebral emboli (ACE), and freedom from atrial arrhythmias. Sixty patients (median age 66 years; 75% male) with paroxysmal (57%) or persistent (43%) AF were randomized to HPSD (n = 29) or SPSD (n = 31). Median time to achieve PVI was shorter with HPSD vs SPSD (87 minutes vs 126 minutes; P = 0.003), as was left atrial dwell time (157 minutes vs 180 minutes; P = 0.04). There were no differences in first-pass isolation (79% vs 76%; P = 0.65) or PV reconnection with adenosine (12% vs 20%; P = 0.26) between groups. At 12 months, recurrent atrial arrhythmias occurred less in the HPSD group compared with the SPSD group (n = 3 of 29 [10%] vs n = 11 of 31 [35%]; HR: 0.26; P = 0.027). There was a trend toward more ACE with HPSD RFA (40% HPSD vs 17% SPSD; P = 0.053). In patients undergoing AF ablation, HPSD compared with SPSD RFA results in shorter time to achieve PVI, greater freedom from AF at 12 months, and a trend toward increased ACE.
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