vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-2022-3-01vestar-1126Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESИзоляция задней стенки левого предсердия при персистирующей форме фибрилляции предсердий не влияет на эффективность катетерной аблации: пилотное исследованиеLeft atrial posterior wall isolation in persistent atrial fibrillation does not influence the efficacy of catheter ablation: a pilot studyhttps://orcid.org/0000-0002-0529-0081КозловА. В.KozlovA. V.

Козлов Александр Викторович

Пенза, ул. Стасова, д. 6

Kozlov Alexander

Penza, 6 Stasova str.

kozlov3619@yandex.ruhttps://orcid.org/0000-0002-4973-510XДурмановС. С.DurmanovS. S.

Пенза, ул. Стасова, д. 6

Penza, 6 Stasova str.

https://orcid.org/0000-0001-6089-9722БазылевВ. В.BazylevV. V.

Пенза, ул. Стасова, д. 6

Penza, 6 Stasova str.

ФГБУ «Федеральный центр сердечно-сосудистой хирургии» Министерства здравоохранения Российской ФедерацииРоссияFederal Center for Cardiovascular Surgery the Ministry of Health of the Russian FederationRussian Federation202220092022293512Copyright © Козлов А.В., Дурманов С.С., Базылев В.В., 20222022Козлов А.В., Дурманов С.С., Базылев В.В.Kozlov A.V., Durmanov S.S., Bazylev V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1126Цель

Цель. Изучить роль изоляции задней стенки левого предсердия (ЗСЛП) в повышении клинической эффективности радиочастотной аблации (РЧА) у больных с персистирующей формой фибрилляции предсердий (ФП) при плановых внутрисердечных электрофизиологических исследованиях (ВС ЭФИ).

Материал и методы исследования. Исследование одноцентовое рандомизированное проспективное. С февраля 2020 по февраль 2021 года прооперировано 35 больных с персистирующей формой ФП. Пациенты были рандомизированы на группу изоляции устьев легочных вен (УЛВ) плюс изоляция ЗСЛП по схеме «box lesion» (первая группа) и группу только изоляции УЛВ (вторая группа). При невозможности достичь изоляции ЗСЛП выполнялся «debulking». Через 3 месяца вне зависимости от клинического статуса выполнялась процедура ВС ЭФИ и повторная РЧА зон реконнекции.

Результаты

Результаты. Полный протокол исследования прошло 30 человек - 14 в первой группе и 16 во второй. Характеристики пациентов по группам статистически не различались по основным показателям. Длительность первичной и повторной процедур, а также время РЧА при первичной процедуре в первой группе значимо больше, чем во второй. УЛВ изолированы у всех больных, участвующих в исследовании. В первой группе только в 21,4% случаев (3 больных) удалось достигнуть изоляции ЗСЛП, в остальных 78,6% случаев (11 пациентов) выполнялся «debulking». При ВС ЭФИ изоляция УЛВ в первой группе сохранялась в 78,6% случаев (11 пациентов), во второй в 56,2% (9 больных), разница статистически не значима (p=0,209). В первой группе изоляция ЗСЛП сохранялась у 28,6% пациентов (4 больных). Всем больным с реконнекцией была выполнена РЧА с устранением прорывов проведения возбуждения. В среднеотдаленные сроки (440±82,1 дней) наблюдения синусовый ритм сохранился в первой группе у 11 пациентов из 14 (78,5%), во второй у 13 из 16 (81,2%) больных. Статистически достоверной разницы между группами не выявлено (ОШ 0,846 95% ДИ 0,141-5,070 p=0,641).

Заключение

Заключение. В нашем исследовании изоляция ЗСЛП в дополнении к изоляции УЛВ у больных с персистирующей формой ФП не улучшила эффективность лечения при достоверно большей длительности операции и времени РЧА.

Aim

Aim. To study the role of left atrial posterior wall (LAPW) isolation in increasing the clinical efficacy of radiofrequency ablation (RFA) in patients with persistent atrial fibrillation (PeAF) during electrophysiological studies.

Methods

Methods. A single-center randomized prospective study. From February 2020 to February 2021, 35 procedures were performed on patients with PeAF. Patients were randomized into two groups - pulmonary vein isolation (PVI) plus LAPW isolation according to the “box lesion” scheme (the first group) and the PVI-only group (the second group). If it was impossible to achieve LAPW isolation, “debulking” was performed. After 3 months, regardless of the clinical status, EPS and RFA of the reconnection zones were performed.

Results

Results. The full study protocol study was completed by 30 patients - 14 in the first group and 16 in the second group. The characteristics of the patients in the groups did not differ statistically. The duration of the primary and redo procedures, as well as the RFA time during the primary procedure in the first group is significantly longer than in the second group. Pulmonary veins were isolated in all patients participating in the study. In the first group, LAPW isolation was achieved only in 21.4% of cases (3 patients), in the remaining 78.6% of cases (11 patients) “debulking” was performed. PVI in the first group was maintained in 78.6% of cases (11 patients), and in the second group in 56.2% (9 patients), the difference was not statistically significant (p=0.209). In the first group, LAPW isolation was maintained in 28.6% of patients (4 patients). All patients with reconnection underwent RFA with the restoration of the conduction block. In the midterm (440±82.1 days) of follow-up, the sinus rhythm was preserved in the first group in 11 patients (78.5%), and in the second group in 13 (81.2%) patients. There was no statistically significant difference between the groups (OR 0.846 95% CI 0.141-5.070, p=0.641).

Conclusions

Conclusions. In our study, LAPW isolation in addition to PVI in patients with PeAF did not improve the efficacy of treatment with a significantly longer duration of procedure and RFA time.

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The authors declare that there are no conflicts of interest present.