Факторы, ассоциированные с эффективностью радиочастотной катетерной аблации фибрилляции предсердий: мнение специалистов, применяющих технологию «индекс аблации»

В настоящем документе изложены обзор современных проблем и тенденций в катетерном лечении фибрилляции предсердий, анализ мнений специалистов об аспектах и параметрах радиочастотной аблации, полученных в ходе электронного опроса, а также подходов к повышению эффективности и безопасности радиочастотной катетерной аблации фибрилляции предсердий.

фибрилляция предсердий, радиочастотная аблация, параметры аблации, индекс аблации, экспертное мнение

1. Shkolnikova MA, Jdanov DA, Ildarova RA, et al. Atrial fibrillation among Russian men and women aged 55 years and older: prevalence, mortality, and associations with biomarkers in a population-based study. J Geriatr Cardiol. 2020;17(2): 74-84. DOI: 10.11909/j.issn.1671- 5411.2020.02.002.

2. Odutayo A, Wong CX, Hsiao AJ, et al. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ. 2016; 354: i4482. DOI: 10.1136/bmj.i4482.

3. Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency Ablation vs Antiarrhythmic Drugs as First-Line Treatment of Paroxysmal Atrial Fibrillation (RAAFT-2) A Randomized Trial. JAMA. 2014 Feb 19;311(7): 692-700. DOI: 10.1001/jama.2014.467.

4. Packer DL, Kowal RC, Wheelan KR, et al. Cryoballoon Ablation of Pulmonary Veins for Paroxysmal Atrial Fibrillation: First Results of the North American Arctic Front (STOP AF) Pivotal Trial. J Am Coll Cardiol. 2013 Apr 23;61(16): 1713-23. DOI: 10.1016/j.jacc.2012.11.064.

5. Marrouche NF, Brachmann J, Andresen D, et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. New England Journal of Medicine. 2018;378(5): 417-27. DOI: 10.1056/NEJMoa1707855.

6. Гасымова НЗ, Михайлов ЕН, Оршанская ВС и др. Обратное ремоделирование сердца после катетерной аблации фибрилляции предсердий у пациентов с сердечной недостаточностью и низкой фракцией выброса левого желудочка. Кардиология. 2019;59(8S): 37-43. DOI: 10.18087/cardio.2671.

7. Hindricks G, Camm J, Merkely B, et al. The EHRA White Book 2017. The current status of cardiac electrophysiology in ESC member countries. Available from URL https://www.escardio.org/static_file/Escardio/Subspecialty/EHRA/Publications/Documents/2017/ehra-whitebook-2017.pdf.

8. Shah RU, Freeman JV, Shilane D, et al. Complications, Rehospitalizations, and Repeat Procedures After Catheter Ablation for Atrial Fibrillation. J Am Coll Cardiol. 2012; 59(2): 143-149. DOI: 10.1016/j.jacc.2011.08.068.

9. Cheung JW, Yeo I, Cheng E, et al. Inpatient hospital procedural volume and outcomes following catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2020; 31(7):1-32 DOI: 10.1111/jce.14584.

10. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275-444. DOI: 10.1093/europace/eux274.

11. Pecha S, Ghandili S, Hakmi S, et al. Predictors of Long-term Success After Concomitant Surgical Ablation for Atrial Fibrillation. Semin Thorac Cardiovasc Surg. 2017;29(3): 294-298. DOI: 10.1053/j.semtcvs.2017.08.01.

12. Михайлов ЕН, Гасымова НЗ, Байрамова СА и др. Клиническая характеристика пациентов и результаты катетерной аблации фибрилляции предсердий в российской популяции: субанализ европейского регистра 2012-2016гг. Российский кардиологический журнал. 2018;(7):7-15. DOI:10.15829/1560-4071-2018-7-7-15.

13. Pathak RK, Middeldorp ME, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol. 2014;64(21): 2222-2231. DOI: 10.1016/j.jacc.2014.09.028.

14. Dimitri H, Ng M, Brooks AG, et al. Atrial remodeling in obstructive sleep apnea: implications for atrial fibrillation. Heart Rhythm. 2012;9(3): 321-327. DOI: 10.1016/j. hrthm.2011.10.017.

15. Li L, Wang Z-W, Jie Li, et al. Efficacy of catheter ablation of atrial fibrillation in patients with obstructive sleep apnoea with and without continuous positive airway pressure treatment: a meta-analysis of observational studies. Europace. 2014; 16(9):1309-1314. DOI: 10.1093/europace/euu066.

16. Santoro F, Di Biase L, Trivedi C, et al. Impact of Uncontrolled Hypertension on Atrial Fibrillation Ablation Outcome. JACC: Clinical Electrophysiology. 2015;1(3): 164-173. DOI: 10.1016/j.jacep.2015.04.002.

17. Qiao Y, Shi R, Hou B, et al. Impact of alcohol consumption on substrate remodeling and ablation outcome of paroxysmal atrial fibrillation. J Am Heart Assoc. 2015;4(11): e002349. DOI: 10.1161/JAHA.115.002349.

18. Mikhaylov EN, Orshanskaya VS, Lebedev AD, Szili-Torok T, Lebedev DS. Catheter ablation of paroxysmal atrial fibrillation in patients with previous amiodarone-induced hyperthyroidism: a case-control study. Journal of Cardiovascular Electrophysiology. 2013;24(8): 888-893. DOI: 10.1111/jce.12140.

19. Winkle RA, Jarman JWE, Mead H, et al. Predicting Atrial Fibrillation Ablation Outcome: The CAAP-AF Score. Heart Rhythm. 2016;13(11): 2119-2125. DOI: 10.1016/j.hrthm.2016.07.018.

20. Kornej J, Hindricks G, Arya A, et al. The APPLE Score - A Novel Score for the Prediction of Rhythm Outcomes after Repeat Catheter Ablation of Atrial Fibrillation. PLoS One. 2017; 12(1): e0169933. DOI: 10.1371/journal. pone.0169933.

21. Jud FN, Obeid S, Duru F, Haegeli LM. A novel score in the prediction of rhythm outcome after ablation of atrial fibrillation: The SUCCESS score. Anatol J Cardiol. 2019; 21(3): 142-149. DOI: 10.14744/AnatolJCardiol.2018.76570.

22. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37: 2893-962. DOI: 10.1093/eurheartj/ehw210.

23. Ревишвили АШ, Шляхто ЕВ, Сулимов ВА и др. Клинические рекомендации: «Диагностика и лечение фибрилляции предсердий». Москва, 2017; 211 с.

24. Glover BM, Hong KL, Dagres N, et al. Impact of Body Mass Index on the Outcome of Catheter Ablation of Atrial Fibrillation. Heart. 2019;105(3): 244-250. DOI: 10.1136/ heartjnl-2018-313490.

25. Gianni C, Perez MV, Al-Ahmad A, Natale A. How to perform pulmonary vein antral isolation for atrial fibrillation. In Hands-on ablation experts’ approaches second edition (Ed. Al-Ahmad A, Callans DJ, Hsia HH, Natale A, Oseroff O, Wang PJ). Minneapolis 2017: 135-145 ISBN 978-1-942909-17-0.

26. Duytschaever M, O’Neill M, Martinek M. Increasing the Single-Procedure Success Rate of Pulmonary Vein Isolation. Arrhythmia & Electrophysiology Review. 2017;6(4): 217-221. DOI: 10.15420/aer.2017.38/1.

27. Della Rocca DG, Di Biase L, Tarantino N, et al. Single procedure success rate of radiofrequency catheter ablation of persistent atrial fibrillation results from a prospective, multicentre, observational registry. Journal of the American College of Cardiology. 2020 75(11): 509. DOI: 10.1016/S0735-1097(20)31136-0.

28. Mikhaylov EN, Lebedev DS, Pokushalov EA, et al. Outcomes of cryoballoon ablation in high- and low-volume atrial fibrillation ablation centres: a Russian pilot survey. BioMed Research International. 2015;2015: 591603. DOI: 10.1155/2015/591603.

29. Joshi S, Choi AG, Kamath GS, et al. Prevalence, predictors, and prognosis of atrial fibrillation early after pulmonary vein isolation: findings from 3 months of continuous automatic ECG loop recordings. J Cardiovasc Electrophysiol. 2009;20(10): 1089-1094. DOI: 10.1111/j.1540- 8167.2009.01506.x.

30. Andrade JG, Khairy P, Verma A, et al. Early recurrence of atrial tachyarrhythmias following radiofrequency catheter ablation of atrial fibrillation. Pacing Clin Electrophysiol. 2012;35: 106-116 (2012). DOI: 10.1111/j.1540- 8159.2011.03256.x.

31. Andrade JG, Khairy P, Macle L, et al. Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation: insights from the multicenter Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) Trial. Circ Arrhythm Electrophysiol. 2014;7(1):69-75. DOI: 10.1161/CIRCEP.113.000586.

32. Andrade JG, Khairy P, Macle L, et al. Incidence and significance of early recurrences associated with different ablation strategies for AF: a STAR-AF substudy. J Cardiovasc Electrophysiol 2012;23(12):1295-1301. DOI: 10.1111/j.1540-8167.2012.02399.x.

33. Liang JJ, Dixit S. Early Recurrences During the Blanking Period after Atrial Fibrillation Ablation. J Atr Fibrillation. 2018;10(5): 1726. DOI: 10.4022/jafib.1726.

34. Liang JJ, Dixit S, Santangeli P. Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation. World J Car-diol. 2016;8(11): 638-646. DOI: 10.4330/wjc.v8.i11.638.

35. Коробченко ЛЕ, Байрамова СА., Харац ВЕ и др. Динамика антиаритмической терапии после катетерной аблации фибрилляции предсердий: данные российской клинической практики в регистре ESC-EHRA. Российский кардиологический журнал. 2020;25(5):3874. DOI:10.15829/1560-4071- 2020- 3874]doi:10.15829/1560-4071-2020-3874.

36. Kaitani K, Inoue K, Kobori A, et al. Efficacy of Antiarrhythmic Drugs Short-Term Use After Catheter Ablation for Atrial Fibrillation (EAST-AF) trial. Eur Heart J. 2016;37(7): 610-8. DOI: 10.1093/eurheartj/ehv501.

37. Leong-Sit P, Roux J-F, Zado E, et al. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study): Six-Month Follow-Up Study Circ Arrhythm Electrophysiol. 2011;4(1): 11-4. DOI: 10.1161/CIRCEP.110.955393.

38. Duytschaever M, Demolder A, Phlips T, et al. PulmOnary Vein Isolation With vs. Without Continued Antiarrhythmic Drug trEatment in Subjects With Recurrent Atrial Fibrillation (POWDER AF): Results From a Multicentre Randomized Trial. Eur Heart J. 2018;39(16): 1429-1437. DOI: 10.1093/eurheartj/ehx666.

39. Yoo Ri Kim 1, Gi-Byoung Nam 2, Seungbong Han, et al. Effect of Short-Term Steroid Therapy on Early Recurrence During the Blanking Period After Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2015;8(6): 1366-72. DOI: 10.1161/CIRCEP.115.002957.

40. Imazio M, Brucato A, Ferrazzi P, et al. Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy. Circulation. 2011;124(21): 2290-2295. DOI: 10.1161/CIRCULATIONAHA.

41. Deftereos S, Giannopoulos G, Kossyvakis C, et al. Colchicine for prevention of early atrial fibrillation recurrence after pulmonary vein isolation: a randomized controlled study. J Am Coll Cardiol. 2012;60(18): 1790-1796. DOI: 10.1016/j.jacc.2012.07.031.

42. Deftereos S, Giannopoulos G, Efremidis M, et al. Colchicine for prevention of atrial fibrillation recurrence after pulmonary vein isolation: mid-term efficacy and effect on quality of life. Heart Rhythm. 2014;11(4): 620-628. DOI: 10.1016/j.hrthm.2014.02.002.

43. Anné W, Willems R, Van der Merwe N, et al. Atrial fibrillation after radiofrequency ablation of atrial flutter: preventive effect of angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, and diuretics. Heart. 2004; 90(9): 1025-1030. DOI: 10.1136/hrt.2003.023069.

44. Whitaker J, Fish J, Harrison J, et al. MD. Lesion index-guided ablation facilitates continuous, transmural, and durable lesions in a porcine recovery model. Circ Arrhythm Electrophysiol. 2018;11: e005892. DOI: 10.1161/ CIRCEP.117.005892.

45. Chae S, Oral H, Good E, et al. Atrial tachycardia after circumferential pulmonary vein ablation of atrial fibrillation: mechanistic insights, results of catheter ablation, and risk factors for recurrence. J Am Coll Cardiol. 2007;50: 1781-1787. DOI: 10.1016/j.jacc.2007.07.044.

46. Kimura M, Sasaki S, Owada S, et al. Comparison of lesion formation between contact force‐guided and non-guided circumferential pulmonary vein isolation: a prospective, randomized study. Heart Rhythm. 2014;11: 984-91. DOI: 10.1016/j.hrthm.2014.03.019.

47. Andrade JG, Monir G, Pollak SJ, et al. Pulmonary vein isolation using “contact force” ablation: the effect on dormant conduction and long‐term freedom from recurrent atrial fibrillation - a prospective study. Heart Rhythm. 2014;11: 1919-24. DOI: 10.1016/j.hrthm.2014.07.033.

48. Мамчур СЕ, Хоменко ЕА, Горбунова ЕВ и др. Качество контакта аблационного электрода с тканью при катетерной аблации фибрилляции предсердий в зависимости от опыта электрофизиолога. Вестник аритмологии. 2015;80:5-10.

49. Neuzil P, Reddy VY, Kautzner J, et al. Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial Treatment: Results From the EFFICAS I Study. Circ Arrhythm Electrophysiol. 2013;6(2): 327-33. DOI: 10.1161/CIRCEP.113.000374.

50. Kautzner J, Neuzil P, Lambert H, et al. EFFICAS II: Optimization of Catheter Contact Force Improves Outcome of Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation. Europace. 2015;17(8): 1229-35. DOI: 10.1093/europace/euv057.

51. Black-Maier E, Pokorney SD, Barnett AS. Risk of Atrioesophageal Fistula Formation With Contact Force-Sensing Catheters. Heart Rhythm. 2017 Sep;14(9):1328-1333. DOI: 10.1016/j.hrthm.2017.04.024.

52. Pranata R, Vania R, Huang I. Ablation-index guided versus conventional contact-force guided ablation in pulmonary vein isolation - systematic review and meta-analysis. Indian Pacing Electrophysiol J. 2019;19(4): 155-160. DOI: 10.1016/j.ipej.2019.05.001.

53. Hussein A, Das M, Riva S, et al. Use of ablation index-guided ablation results in high rates of durable pulmonary vein isolation and freedom from arrhythmia in persistent atrial fibrillation patients. Circulation: Arrhythmia and Electrophysiology. 2018;11: e006576. DOI: 10.1161/ CIRCEP.118.006576.

54. Phlips T, Taghji P, El Haddad M, et al. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ‘CLOSE’-protocol. Europace. 2018;20(FI_3): 419-427. DOI: 10.1093/europace/eux376.

55. Lee SR, Choi EK, Lee EJ, et al. Efficacy of the optimal ablation index-targeted strategy for pulmonary vein isolation in patients with atrial fibrillation: the OPTIMUM study results. J Interv Card Electrophysiol. 2019;55(2): 171-181. DOI: 10.1007/s10840-019-00565-4.

56. Das M, Loveday JJ, Wynn GJ, et al. Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values. Europace. 2017;19: 775-83. DOI: 10.1093/europace/euw105.

57. Taghji P, El Haddad M, Phlips T, et al. Evaluation of a strategy aiming to enclose the pulmonary veins with contiguous and optimized radiofrequency lesions in paroxysmal atrial fibrillation: a pilot study. JACC: Clinical Electrophysiology. 2018;4(1): 99-108. DOI: 10.1016/j.jacep.2017.06.023.

58. Gasimova NZ, Kolunin GV, Artyukhina EA, et al. Prospective Registry of Atrial Fibrillation Ablation with the Ablation Index Technology: Rationale and Study Design. Cardiology. 2020; [article in press].

59. Valles E, Fan R, Roux JF, et al. Localization of Atrial Fibrillation Triggers in Patients Undergoing Pulmonary Vein Isolation: Importance of the Carina Region. J Am Coll Cardiol. 2008;52(17): 1413-20. DOI: 10.1016/j. jacc.2008.07.025.

60. Kumagai K, Naito S, Nakamura K, et al. ATP-induced Dormant Pulmonary Veins Originating From the Carina Region After Circumferential Pulmonary Vein Isolation of Atrial Fibrillation. J Cardiovasc Electrophysiol. 2010;21(5):494-500. DOI: 10.1111/j.1540- 8167.2009.01667.x.

61. Hussein A, Das M, Riva S, et al. Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom From Arrhythmia in Persistent Atrial Fibrillation Patients The PRAISE Study Results. Circ Arrhythm Electrophysiol. 2018;11: e006576. DOI: 10.1161/CIRCEP.118.006576.

62. Squara F, Liuba I, Chik W, et al. Electrical Connection Between Ipsilateral Pulmonary Veins: Prevalence and Implications for Ablation and Adenosine Testing. Heart Rhythm. 2015 Feb;12(2):275-82. DOI: 10.1016/j. hrthm.2014.11.003.

63. Casaclang-Verzosa G, Gersh BJ, Tsang TS. Structural and functional remodeling of the left atrium: Clinical and therapeutic implications for atrial fibrillation. Journal of the American College of Cardiology. 2008;51: 1-11. DOI: 10.1016/j.jacc.2007.09.026.

64. Platonov PG, Mitrofanova LB, Orshanskaya VS, Ho SY. Structural Abnormalities in Atrial Walls Are Associated With Presence and Persistency of Atrial Fibrillation But Not With Age. J Am Coll Cardiol. 2011: 2225-32. DOI: 10.1016/j.jacc.2011.05.061.

65. Akoum N, Daccarett M, Mcgann C, et al. Atrial Fibrosis Helps Select the Appropriate Patient and Strategy in Catheter Ablation of Atrial Fibrillation. A DE-MRI Guided Approach. J Cardiovasc Electrophysiol. 2011; 22(1): 16- 22. DOI: 10.1111/j.1540-8167.2010.01876.x.

66. Оршанская ВС, Каменев АВ, Белякова ЛА и др. Электроанатомический субстрат левого предсердия и его прогностическая ценность при определении риска рецидива фибрилляции предсердий после циркулярной изоляции легочных вен. Результаты проспективного обсервационного исследования. Российский кардиологический журнал. 2017;8(148): 82-89. DOI: 10.15829/1560-4071-2017-8-82-89.

67. Verma A, Jiang C-Y, Betts TR, et al. Approaches to Catheter Ablation for Persistent Atrial Fibrillation. N Engl J Med. 2015;372: 1812-1822 DOI: 10.1056/NEJMoa1408288.

68. Mikhaylov E, Gureev S, Szili-Torok T, Lebedev D. Additional left atrial septal line does not improve outcome of patients undergoing ablation for long-standing persistent atrial fibrillation. Acta Cardiologica. 2010; 65(2): 153-160. DOI: 10.2143/AC.65.2.2047048.

69. Kircher S, Arya A, Altmann D, et al. Individually tailored vs. standardized substrate modification during radiofrequency catheter ablation for atrial fibrillation: a randomized study. Europace. 2017;20(11):1766-1775. DOI:10.1093/europace/eux310.

70. Vijayaraman P, Netrebko P, Geyfman V, et al. Esophageal Fistula Formation Despite Esophageal Monitoring and Low-Power Radiofrequency Catheter Ablation for Atrial Fibrillation. Circ Arrhythmia Electrophysiol. 2009;2: e31-e33. DOI: 10.1161/CIRCEP.109.883694.

71. Kuwahara T, Takahashi A, Okubo K, et al. Oesophageal cooling with ice water does not reduce the incidence of oesophageal lesions complicating catheter ablation of atrial fibrillation: randomized controlled study. Europace. 2014;16(6): 834-839. DOI: 10.1093/europace/eut368.

72. Koruth JS, Reddy VY, Miller MA, et al. Mechanical esophageal displacement during catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2012;23(2):147- 154. DOI: 10.1111/j.1540-8167.2011.02162.x.

73. Letsas KP, Georgopoulos S, Efremidis M, et al. Adenosine-guided radiofrequency catheter ablation of atrial fibrillation: a metaanalysis of randomized control trials. J Arrhythm. 2017;33: 247-55.

74. Jiang К, Chen M, Yang B, et al. Intraprocedural endpoints to predict durable pulmonary vein isolation: a randomized trial of four post-ablation techniques. Europace. 2019; 1-9 DOI :10.1093/europace/euz301.

75. Di Biase L, Conti S, Mohanty P, et al. General Anesthesia Reduces the Prevalence of Pulmonary Vein Reconnection During Repeat Ablation When Compared With Conscious Sedation: Results From a Randomized Study. Heart Rhythm. 2011;8(3): 368-72. DOI: 10.1016/j. hrthm.2010.10.043.

76. Di Biase L, Saenz LS, Burkhardt DJ, et al. Esophageal Capsule Endoscopy After Radiofrequency Catheter Ablation for Atrial Fibrillation: Documented Higher Risk of Luminal Esophageal Damage With General Anesthesia as Compared With Conscious Sedation. Circ Arrhythm Electrophysiol. 2009;2(2): 108-12. DOI: 10.1161/CIRCEP.108.815266.

77. Cappato R, Calkins H, Chen SA, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005;111(9): 1100-5. DOI: 10.1161/01.CIR.0000157153.30978.67.

78. Sairaku A, Yoshida Y, Nakano Y, et al. Who is the operator, that is the question: a multicentre study of catheter ablation of atrial fibrillation? Europace. 2016;18(9):1352- 6. DOI: 10.1093/europace/euv424.

79. Solimene F, Lepillier A, De Ruvo E, et al. Reproducibility of acute pulmonary vein isolation guided by the ablation index. Pacing Clin Electrophysiol. 2019;42: 874- 881. DOI: 10.1111/pace.13710.

80. Duytschaever M, Vijgen J, De Potter T, et al. Repro-ducibility and acute efficacy of a standardized approach to isolate the pulmonary veins: results from multicenter VISTAX study. European Heart Journal. 2018, ehy566. P6227. DOI: 10.1093/eurheartj/ehy566.P6227.

81. Stabile G, Lepillier A, De Ruvo E, et al.. Reproducibility of pulmonary vein isolation guided by the ablation index: 1‐year outcome of the AIR registry. J Cardiovasc Electrophysiol. 2020; 1-8. DOI: 10.1111/jce.14531.