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薛定谔的猫
(2025-02-28 22:53):
#paper DOI： 10.1038/s41591-025-03517-w
Artificial intelligence for individualized treatment of persistent atrial fibrillation: a randomized controlled trial。心房颤动是最常见的心律失常之一，传统上基于解剖的心脏射频消融术有复发率高的缺点。TAILORED-AF是一项多中心RCT研究，旨在比较传统肺静脉隔离（PVI）与PVI基础上联合人工智能（基于一种识别电活动时空离散区的算法Volta AF Xplorer）两种术式的复发率。研究的主要终点为单次消融术后12月无房颤复发，次要终点为无任何房性心律失常事件，安全性终点为死亡、脑血管事件或治疗相关严重不良事件。在主要终点上个体化消融组显著优于解剖消融组（88％比70％，p＜0.0001），在次要终点和安全性终点上两组无显著差异。
Nature Medicine,
2025-2-14.
DOI: 10.1038/s41591-025-03517-w
Abstract:
Abstract Although pulmonary vein isolation (PVI) has become the cornerstone ablation procedure for atrial fibrillation (AF), the optimal ablation procedure for persistent and long-standing persistent AF remains elusive. Targeting spatio-temporal …
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Abstract Although pulmonary vein isolation (PVI) has become the cornerstone ablation procedure for atrial fibrillation (AF), the optimal ablation procedure for persistent and long-standing persistent AF remains elusive. Targeting spatio-temporal electrogram dispersion in a tailored procedure has been suggested as a potentially beneficial alternative to a conventional PVI-only procedure. In this multicenter, randomized, controlled, double-blind, superiority trial, patients with drug-refractory persistent AF were randomly assigned to a tailored ablation procedure targeting areas of spatio-temporal dispersion, as detected by an artificial intelligence (AI) algorithm, in addition to PVI (tailored arm, n = 187, 23% women) or to a conventional PVI-only procedure (anatomical arm, n = 183, 19% women). The primary efficacy endpoint was freedom from documented AF with or without antiarrhythmic drugs at 12 months after a single ablation procedure. Secondary endpoints included freedom from any atrial arrhythmic events, and the secondary composite safety endpoint consisted of death, cerebrovascular events, or treatment-related serious adverse events. One year post-procedure, the trial met its primary efficacy endpoint, which was achieved in 88% of patients in the tailored arm compared with 70% of patients in the anatomical arm (log-rank P < 0.0001 for superiority). However, no significant difference between arms was observed for the freedom from any atrial arrhythmia endpoint after one ablation. The safety endpoint did not differ between arms, with procedure and ablation times being twice as long in the tailored arm. These results show that AI-guided ablation of spatio-temporal dispersion areas in addition to PVI is superior to PVI alone in eliminating AF at 1-year follow-up in patients with persistent and long-standing persistent AF. Ablation of subsequent organized atrial tachycardias may be needed to maintain sinus rhythm long term. ClinicalTrials.gov identifier: NCT04702451.
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