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Circumferential Pulmonary Vein Isolation Plus Low-Voltage Area Modification in Persistent Atrial Fibrillation: The STABLE-SR-II Trial

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机构： [1]The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. [2]The First Affiliated Hospital of Zhejiang University, Hangzhou, China. [3]Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China. [4]First People's Hospital of Yunnan Province, Kunming, China. [5]Beijing Chaoyang Hospital affiliated to Capital Medical University, Beijing, China. [6]Guangdong Province People's Hospital, Guangzhou, China. [7]Yuhuangding Hospital, Yantai, China. [8]The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. [9]Wannan Medical College Affiliated Yijishan Hospital, Wuhu, China. [10]Zhongshan Hospital, Fudan University, Shanghai, China. [11]The Second Hospital of Hebei Medical University, Shijiazhuang, China. [12]The Affiliated ZhongDa Hospital and Institute of Cardiovascular Disease, Southeast University, Nanjing, China. [13]Tianjin Chest Hospital, Tianjin, China. [14]Department of Cardiology, National University Heart Centre Singapore, Singapore

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Benefits of adjunctive ablation strategies beyond circumferential pulmonary vein isolation (CPVI) are uncertain in patients with persistent atrial fibrillation (PeAF).This study sought to compare clinical outcomes of CPVI plus low-voltage area (LVA) modification during STABLE-SR (SubsTrate ABlation in the LEft Atrium during Sinus Rhythm) vs circumferential pulmonary vein isolation (CPVI) alone in patients with PeAF.From March 2018 to August 2019, 300 patients with PeAF who underwent de novo ablation were recruited and prospectively randomized to either STABLE-SR group (n = 150) or CPVI alone (n = 150) group. In the STABLE-SR group, after CPVI, high-density voltage mapping of left atrium (LA) was performed during sinus rhythm, and additive ablation targeted LVA and complex electrograms, if any were present. All the ablations were titrated by ablation index. The primary endpoint was freedom from documented atrial arrhythmias lasting for ≥30 s without the use of antiarrhythmic drugs, after a single ablation procedure and blanking period of 3 months.After 18 months, atrial-arrhythmia-free survival did not differ significantly between STABLE-SR group and CPVI alone group (67.2% vs 67.4%; HR: 0.89; 95% CI: 0.55-1.36; P = 0.52). Only around one-half of the patients (50.2%) had abnormal LA substrate with a medium LVA burden of 4.6% (2.1%-9.5%). However, the success rate differs dramatically between patients with normal vs abnormal LA substrate (84.8% vs 60.9%; P < 0.001).Additional LVA ablation did not improve successful rates of CPVI in this PeAF cohort, of whom one-half had normal LA substrate. Voltage map could identify patients with PeAF with normal LA substrate who can achieve excellent rhythm control with CPVI alone. (CPVI Alone Versus CPVI Plus Electrophysiological Substrate Ablation in the LA During SR for the Treatment of Non-PAF [STABLE-SR_II]; NCT03448562).Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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出版当年[2022]版：

大类 | 1 区

医学

小类 | 2 区心脏和心血管系统

最新[2023]版：

大类 | 1 区

医学

小类 | 2 区心脏和心血管系统

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出版当年[2021]版：

Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

最新[2023]版：

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

影响因子： 8 最新[2023版] 7.5 最新五年平均 6.124 出版当年[2021版] 0 出版当年五年平均 6.375 出版前一年[2020版] 7 出版后一年[2022版]

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第一作者机构： [1]The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

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通讯机构： [1]The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. [*1]Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China

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