高頻度興奮部位の焼灼は心房細動治療に有効である （LBCT 05/Abstract: 19672）

RADAR-AF：発作性心房細動において、高頻度興奮部位焼灼術は標準治療と比較し安全性および有効性が同等であった
RADAR-AF: Targeted, high frequency source ablation was as safe and effective as standard treatment for paroxysmal atrial fibrillation
発作性心房細動（AF）患者において高頻度興奮部位焼灼術は標準的な焼灼治療と安全性および有効性が同等であるとのlate-breaking clinical trialの結果が2013年American Heart Association学会で発表された。Radiofrequency Catheter Ablation of Drivers vs. Circumferential Pulmonary Vein Isolation in Patients with Atrial FibRillation（RADAR-AF）の研究者らは発作性AFまたは持続性AF患者232人を調査した。発作性AF患者は、左心系に血液を流入させる肺静脈を電気的に隔離する標準的な広範囲肺静脈隔離術、またはコンピュータマッピングを用いて異常心組織を選別するより標的化した方法である高頻度興奮部位焼灼術のいずれかを施行された。1年後に心房細動を有さない確率は、高頻度興奮部位焼灼術を施行された発作性AF患者と広範囲肺静脈隔離術を施行された患者とで同等であった。また重大な合併症は高頻度興奮部位焼灼術群で少なかった。持続性AF患者において、有効性および安全性については2群間で同等であった。現在、研究者らは高密度記録の心電図を行い、焼灼術の前に誤った電気信号を引き起こす心領域を同定しより標的化した治療を試みることを計画して いる。
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High frequency source ablation is as safe and effective as a more standard ablation treatment for patients with paroxysmal atrial fibrillation, according to a late-breaking clinical trial presented at the American Heart Association's Scientific Sessions 2013.

The Radiofrequency Catheter Ablation of Drivers vs. Circumferential Pulmonary Vein Isolation in Patients with Atrial FibRillation (RADAR-AF) researchers looked at 232 patients with paroxysmal atrial fibrillation (AF).

Paroxysmal atrial fibrillation patients underwent either standard circumferential pulmonary vein isolation ablation, which electrically isolates the veins that bring blood to the left side of the heart, or high frequency source ablation, a more targeted approach that uses computer mapping to single out abnormal heart tissue.
The paroxysmal atrial fibrillation patients who underwent high frequency source ablation did equally well as those receiving the circumferential pulmonary vein isolation with a freedom from atrial fibrillation one year after treatment. They also experienced fewer major side effects with high frequency source ablation.

There was no difference in either efficacy or safety in the two groups of persistent atrial fibrillation patients.

"Improved computer systems can analyze the electrical activity of the heart, localize them and through ablation, eliminate those areas faster," said Felipe Atienza, M.D., Ph.D., lead researcher of the study and senior electrophysiologist at Hospital General Universitario, Gregorio Marañón in Madrid, Spain. "This offers a personalized treatment, directed to selectively eliminate the sources causing atrial fibrillation, and is beneficial and safe."

The researchers now plan to try high-density electrocardiograms to identify the areas in the heart causing faulty electrical signals before the intervention to better target treatment.

"Current ablation treatments for atrial fibrillation have reached a 70 percent efficacy ceiling, and more extensive procedures are associated with a higher complication rate," Atienza said. "More advanced computer systems and software programs will enable us to spot the harder-to-reach areas in the heart that are triggering electrical irregularities and correct these abnormalities in less invasive ways."

Co-authors are Jose M. Ormaetxe, M.D.; Ángel Moya, M.D.; Jesús Martínez-Alday, M.D.; Antonio Hernandez-Madrid, M.D.; Eduardo Castellanos, M.D.; Fernando Arribas, M.D.; Miguel Angel Arias, M.D.; Luis Tercedor, M.D.; Rafael Peinado, M.D.; Ángel Arenal, M.D.; Francisco Fdez-Avilés, M.D.; Jesús Almendral, M.D.; and José Jalife, M.D.,

St. Jude Medical Spain (unrestricted grant) and the National Center for Cardiovascular Research, Instituto Carlos III, Spain, funded the study.