Hall Burr, Veerareddy Srikar, Cheung Peter, Good Eric, Lemola Kristina, Han Jihn, Kamala Tamirisa, Chugh Aman, Pelosi Frank, Morady Fred, Oral Hakan
Division of Cardiology, University of Michigan, Ann Arbor, 48109, USA.
Heart Rhythm. 2004 May;1(1):43-8. doi: 10.1016/j.hrthm.2004.01.004.
The purpose of this prospective study was to compare radiofrequency catheter ablation of the cavotricuspid isthmus using a strictly anatomic approach to an approach guided by a bipolar voltage map to avoid high voltage zones in the cavotricuspid isthmus.
It is not clear whether local atrial electrogram amplitude influences the achievement of complete cavotricuspid isthmus block during radiofrequency catheter ablation for atrial flutter.
Thirty-two patients with atrial flutter were randomized to cavotricuspid isthmus ablation using an anatomical approach (group I, 16 patients) or guided by a bipolar voltage map (group II, 16 patients). A 3-dimensional electroanatomic mapping system and an 8-mm-tip ablation catheter were used in all patients. With the anatomical approach, an ablation line was created in the cavotricuspid isthmus at a 6 o'clock position in the 45 degree left anterior oblique projection. During voltage-guided ablation, a high-density bipolar voltage map of the cavotricuspid isthmus was created, and then contiguous applications of radiofrequency energy were delivered to create an ablation line through the cavotricuspid isthmus sites with the lowest bipolar voltage.
Complete cavotricuspid isthmus conduction block was achieved in 100% of patients in each group. The mean maximum voltages along the line were 3.6 +/- 1.5 mV in group I, and 1.2 +/- 0.9 mV in group II (P < .01). Creating a high-density voltage map was associated with approximately 15-minute increase in the total procedure time (P = .2). During a mean follow-up of 177 +/- 40 days, there were no recurrences of atrial flutter in either group. There were no complications in either group.
When cavotricuspid isthmus ablation for atrial flutter is performed with an 8-mm-tip catheter, complete block can be achieved in all patients regardless of local voltage. Ablation of high voltage zones is not associated with a higher recurrence rate. Therefore, anatomic ablation without voltage mapping is the preferred initial approach for cavotricuspid isthmus ablation.
本前瞻性研究的目的是比较使用严格解剖学方法与双极电压图引导方法进行三尖瓣峡部射频导管消融，以避免三尖瓣峡部的高电压区域。
在心房扑动的射频导管消融过程中，局部心房电图振幅是否会影响三尖瓣峡部完全性传导阻滞的实现尚不清楚。
32例心房扑动患者被随机分为使用解剖学方法进行三尖瓣峡部消融的I组（16例患者）和使用双极电压图引导的II组（16例患者）。所有患者均使用三维电解剖标测系统和8毫米尖端消融导管。采用解剖学方法时，在左前斜45度投影的6点钟位置的三尖瓣峡部创建消融线。在电压引导消融过程中，创建三尖瓣峡部的高密度双极电压图，然后通过双极电压最低的三尖瓣峡部部位连续施加射频能量以创建消融线。
每组患者均实现了三尖瓣峡部完全性传导阻滞。I组沿消融线的平均最大电压为3.6±1.5毫伏，II组为1.2±0.9毫伏（P<0.01）。创建高密度电压图与总手术时间增加约15分钟相关（P=0.2）。在平均177±40天的随访期间，两组均无心房扑动复发。两组均无并发症。
使用8毫米尖端导管进行心房扑动的三尖瓣峡部消融时，无论局部电压如何，所有患者均可实现完全性阻滞。消融高电压区域与更高的复发率无关。因此，不进行电压标测的解剖学消融是三尖瓣峡部消融的首选初始方法。
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