Stárek Z, Zaoral L, Leinveber P, Haman L, Csanádi Z, Herman D
I. interní kardio-angiologická klinika Lékarské fakulty MU a FN u sv. Anny, Brno.
Vnitr Lek. 2006 Feb;52(2):132-6.
Radiofrequency ablation of common atrial flutter requires the creation of a complete transmural ablation line across cavotricuspid region to achieve bidirectional conduction block. Irrigated tip catheters facilitate rapid achievement of this block by creation larger and deeper lesions. The EASTHER registry was organized to collect data about the efficacy of the procedure in small and middle volume centres in Central and Eastern Europe, all using THERMOCOOL catheter technology.
Easther is a prospective registry (April 2002-February 2003). 133 consecutive patients (81.1% male, age 59.0 +/- 10.4 years, range 30-81 years) with common atrial flutter were enrolled. Coincidence with atypical flutter was observed in 2.7%. Patients had a history of flutter of 31.0 +/- 53.6 month (range 1-403) and concomitant atrial fibrillation was observed in 42.9%. Structural heart disease was present in 38.9%. Amount of re-ablated cases was 14%. RF energy was applied during 60 sec in power-controlled mode at a setting between 40 to 50 W with an average flow rate of 19.0 ml/min.
Acute success rate defined as bi-directional block was achieved in 93.1%, although 94.7% of cases were assessed successful by the treating electrophysiologist. Average number of RF applications was 12.0 +/- 7.0 (range 2-40) per procedure. Average delivered power varied between a minimum of 36.1 +/- 15.1 W till a maximum of 45.3 +/- 13.0 W, while the average maximum temperature observed at the same time was varied between 39.0 +/- 3.4 degrees C and 45.4 +/- 4.0 degrees C. Total procedure time was 100.1 +/- 42.7 min (range 20-280 min) and fluoroscopy time was 15.8 +/- 9.6 min (range 4-45 min). In comparable French TC registry Average total and fluoroscopy time were 46.4 +/- 33.6 min, and 10.0 +/- 6.8 min resp. In the Middle European centres total and fluoroscopy time was 96.1 +/- 40.9 min, and 15.0 +/- 8.9 min resp. In centres from Eastern Europe it was 120.3 +/- 51.2 min, and 20.4 +/- 11.9 min resp. Two adverse events were reported. Both patients had strong chest pain during ablation. These results are comparable with the literature data published.
Irrigated tip catheters are effective and safe in ablation of common atrial flutter. This technology helps to accelerate and facilitate achievement of bi-directional isthmus block. Most of procedures were terminated to one hour in experienced centers in France as early as 2002. Procedures not exceeding one hour are feasible in case of spreading this method as method of first choice with gaining of experiences in centres of Middle and Eastern Europe.
对于常见心房扑动的射频消融，需要在三尖瓣峡部区域创建一条完整的透壁消融线，以实现双向传导阻滞。灌注导管头端的导管通过形成更大、更深的损伤，有助于快速实现这种阻滞。EASTHER注册研究旨在收集中东欧中小规模中心采用THERMOCOOL导管技术进行该手术疗效的数据。
EASTHER是一项前瞻性注册研究（2002年4月至2003年2月）。连续纳入133例常见心房扑动患者（男性占81.1%，年龄59.0±10.4岁，范围30 - 81岁）。观察到与不典型扑动的重合率为2.7%。患者有扑动病史31.0±53.6个月（范围1 - 403个月），观察到合并心房颤动的比例为42.9%。存在结构性心脏病的比例为38.9%。再次消融的病例数为14%。在功率控制模式下，以40至50瓦的设置施加射频能量60秒，平均流速为19.0毫升/分钟。
定义为双向阻滞的急性成功率为93.1%，尽管94.7%的病例经治疗电生理学家评估为成功。每次手术的平均射频应用次数为12.0±7.0次（范围2 - 40次）。平均输送功率在最低36.1±15.1瓦至最高45.3±13.0瓦之间变化，同时观察到的平均最高温度在39.0±3.4摄氏度至45.4±4.0摄氏度之间变化。总手术时间为100.1±42.7分钟（范围20 - 280分钟），透视时间为15.8±9.6分钟（范围4 - 45分钟）。在法国类似的TC注册研究中，平均总手术时间和透视时间分别为46.4±33.6分钟和10.0±6.8分钟。在中欧中心，总手术时间和透视时间分别为96.1±40.9分钟和15.0±8.9分钟。在东欧中心，分别为120.3±51.2分钟和20.4±11.9分钟。报告了两例不良事件。两名患者在消融过程中均出现剧烈胸痛。这些结果与已发表的文献数据相当。
灌注导管头端的导管在常见心房扑动的消融中有效且安全。该技术有助于加速并促进实现双向峡部阻滞。早在2002年，法国经验丰富的中心大多数手术在一小时内完成。如果将这种方法作为首选方法在中东欧中心推广并积累经验，不超过一小时的手术是可行的。
