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Comparison of the Mid-Term Outcomes of Robotic Magnetic Navigation-Guided Radiofrequency Ablation versus Cryoballoon Ablation for Persistent Atrial Fibrillation
Journal of Cardiovascular Development and Disease Pub Date : 2022-03-17 , DOI: 10.3390/jcdd9030088
Xiang Li 1 , Yangyang Bao 1 , Kangni Jia 1 , Ning Zhang 1 , Changjian Lin 1 , Yue Wei 1 , Yun Xie 1 , Qingzhi Luo 1 , Tianyou Ling 1 , Kang Chen 1 , Wenqi Pan 1 , Liqun Wu 1 , Qi Jin 1
Affiliation  

Introduction: Currently, numerous ablation techniques are available for atrial fibrillation (AF), in addition to manual radio frequency ablation. The aim of this prospective, non-randomized concurrent controlled trial was to compare the mid-term efficacy and procedural outcomes of persistent AF (PerAF) using cryoballoon (CB) and robotic magnetic navigation (RMN). Methods: Two hundred PerAF patients were assigned, in a 1:1 ratio, to undergo catheter ablation using RMN (RMN group) or CB (CB group). The primary endpoint was freedom from AF recurrence following a 3-month period after the index ablation. The secondary endpoint was peri-procedural outcomes, including the total procedure time, left atrial procedure time, fluoroscopy time, and fluoroscopy dose. The Two-step cluster analysis was used to determine the efficacy of RMN and CB between the different groups. The Cox proportional hazard model and restricted cubic spline were used to determine predictors for AF recurrence. Results: At the mean follow-up of 28.1 ± 9.7 months, the primary endpoint was achieved in 71 PerAF patients in the RMN group and in 62 PerAF patients in the CB group (71% vs. 62%, p = 0.158). Compared with CB, RMN-guided ablation led to a longer procedure time (p < 0.001), but with less radiation (p < 0.001). Cluster analysis returned two clusters of patients and RMN was favorable for one cluster (p = 0.037), in which more patients presented with diabetes mellitus and smaller left atria. Conclusions: For patients with PerAF, CB is generally equivalent to RMN-guided ablation with regard to overall efficacy. RMN-guided ablation could be favorable in specific patient populations presenting with diabetes mellitus and smaller left atria.

中文翻译:

机器人磁导航引导射频消融术与冷冻球囊消融术治疗持续性心房颤动的中期结果比较

简介:目前,除手动射频消融外,还有许多消融技术可用于心房颤动 (AF)。这项前瞻性、非随机的同步对照试验的目的是比较使用冷冻球囊 (CB) 和机器人磁导航 (RMN) 治疗持续性房颤 (PerAF) 的中期疗效和手术结果。方法:将 200 名 PerAF 患者按 1:1 的比例分配到使用 RMN(RMN 组)或 CB(CB 组)进行导管消融。主要终点是指数消融后 3 个月后无 AF 复发。次要终点是围手术期结果,包括总手术时间、左心房手术时间、透视时间和透视剂量。两步聚类分析用于确定不同组之间 RMN 和 CB 的功效。Cox 比例风险模型和受限三次样条用于确定 AF 复发的预测因子。结果:在平均随访 28.1 ± 9.7 个月时,RMN 组 71 名 PerAF 患者和 CB 组 62 名 PerAF 患者实现了主要终点(71% 对 62%,p = 0.158)。与 CB 相比,RMN 引导的消融导致更长的手术时间 ( p < 0.001),但辐射更少 ( p < 0.001)。聚类分析返回两组患者,RMN 有利于一组 ( p = 0.037),其中更多患者患有糖尿病和较小的左心房。结论:对于 PerAF 患者,CB 在总体疗效方面通常等同于 RMN 引导的消融。RMN 引导的消融可能对患有糖尿病和较小左心房的特定患者群体有利。
更新日期:2022-03-17
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