Additional Lesion Sets in Ablation of Outflow Tract Premature Ventricular Contractions: A Randomized Clinical Trial.

Autor:	Wang K; Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China., Yi F; Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China., Xiao F; Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Zou C; Department of Cardiology, The First Affiliated Hospital of Soochow University, Soochow, China., Zhang Y; Department of Cardiology, The First Affiliated Hospital of Soochow University, Soochow, China., Wang Y; Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China., Shi L; Department of Cardiology, Affiliated Hospital 2 of Nantong University, Nantong, China., Li C; Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China., Chen L; Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China., Xie S; Department of Cardiology, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China., Shen W; Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing, China., Zhang N; Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China., Wu Q; Department of Cardiology, The Second Affiliated Hospital of Lanzhou University, Lanzhou, China., Xu Q; Department of Cardiology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China., Ji Y; Department of Cardiology, Changzhou No. 2 People's Hospital, the affiliated hospital of Nanjing Medical University, Changzhou, China., Wang C; Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China., Lin Z; Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China., Wei Y; Department of Cardiology, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, China., Ruan Z; Department of Cardiology, Taizhou People's Hospital, Taizhou, China., Sun Y; Department of Cardiology, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai, China., Ju W; Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China., Chen M; Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Jazyk:	angličtina
Zdroj:	JAMA cardiology [JAMA Cardiol] 2024 Nov 01; Vol. 9 (11), pp. 1039-1046.
DOI:	10.1001/jamacardio.2024.2975
Abstrakt:	Importance: Recurrence remains a challenge after ablation of outflow tract premature ventricular contractions (OT-PVCs). Although adding additional lesions next to the index effective ablation site is sometimes performed to reinforce the ablation, it remains uncertain whether this approach is effective. Objective: To test the hypothesis that additional ablation lesions would reduce the recurrence rate compared with single-point ablation at the index effective site for the ablation of OT-PVCs. Design, Setting, and Participants: This study was a multicenter, prospective, randomized clinical trial. Patients receiving their first catheter ablation for OT-PVCs were enrolled from 18 hospitals in China between October 2021 and February 2023. Scheduled follow-up duration was 3 months after the procedure. Intervention: After identifying the target point and eliminating the PVC by a single-point ablation, patients were randomized 1:1 into an additional ablation group or a control group. Main Outcomes and Measures: The primary end point of the study was freedom from PVC recurrence (≥80% reduction of PVC burden, which is the number of PVCs in 24 hours/total heartbeats in 24 hours × 100%) from baseline to 3 months postprocedure. Results: Of 308 patients enrolled in the study, 286 (mean [SD] age, 49.2 [14.6] years; 173 female [60.5%]) were randomized to the additional ablation or the control group. The additional ablation group had a mean (SD) of 6.3 (1.1) radiofrequency applications, whereas the control group (single-point ablation group) had a mean (SD) of 1 (0) radiofrequency application. After a median (IQR) follow-up of 3.2 (0) months, the rate of freedom from PVCs was significantly higher in the additional ablation group (139 of 142 [97.9%]) compared with the control group (115 of 139 [82.7%]; P < .001). Patients in the additional ablation group also had a more substantial reduction in PVC burden than the control group (mean [SD] reduction, 23.0% [10.5%] vs 19.0% [10.4%]; P = .002). There were no severe periprocedural complications in either group. Conclusions and Relevance: This randomized clinical trial showed a benefit of additional ablation in reducing the recurrence of OT-PVCs compared with the single-point ablation strategy, without increased complication risk. Additional ablations surrounding the index effective ablation point should be considered in OT-PVC ablation. Trial Registration: Chinese Clinical Trials Registry Identifier: ChiCTR2200055340.
Databáze:	MEDLINE
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