Kanj Mohamed H, Wazni Oussama, Fahmy Tamer, Thal Sergio, Patel Dimpi, Elayi Claude, Di Biase Luigi, Arruda Mauricio, Saliba Walid, Schweikert Robert A, Cummings Jennifer E, Burkhardt J David, Martin David O, Pelargonio Gemma, Dello Russo Antonio, Casella Michela, Santarelli Pietro, Potenza Domenico, Fanelli Raffaele, Massaro Raimondo, Forleo Giovanni, Natale Andrea
Cleveland Clinic, Cleveland, Ohio.
Cleveland Clinic, Cleveland, Ohio; University of Insubria, Varese, Italy.
J Am Coll Cardiol. 2007 Apr 17;49(15):1634-1641. doi: 10.1016/j.jacc.2006.12.041. Epub 2007 Apr 2.
We sought to test how catheter ablation using an open irrigation catheter (OIC) compares with standard catheters for pulmonary vein antrum isolation.
Open irrigation catheters have the advantage of delivering greater power without increasing the temperature of the catheter tip, which enables deeper and wider lesions without the formation of coagulum on catheters.
Catheter ablation was performed using an 8-mm catheter (8MC) or an OIC. Patients were randomized to 3 groups: 8MC; OIC-1, OIC with a higher peak power (50 W); and OIC-2, OIC with lower peak power (35 W).
A total of 180 patients were randomized to the 3 treatment strategies. Isolation of pulmonary vein antra was achieved in all patients. The freedom from atrial fibrillation was significantly greater in the 8MC and OIC-1 groups compared with the OIC-2 group (78%, 82%, and 68%, respectively, p = 0.043). Fluoroscopy time was lower in OIC-1 compared with OIC-2 and 8MC (28 +/- 1 min, 53 +/- 2 min, and 46 +/- 2 min, respectively, p = 0.001). The mean left atrium instrumentation time was lower in the OIC-1 compared with the OIC-2 and 8MC groups (59 +/- 3 min, 90 +/- 5 min, and 88 +/- 4 min, respectively, p = 0.001). However, there was a greater incidence of "pops" in the OIC-1 (100%, 0%, 0%, p < 0.001) along with higher incidences of pericardial effusion (20%, 0%, 0%, p < 0.001) and gastrointestinal complaints (17% in OIC-1, 3% in 8MC, and 5% in OIC-2, p = 0.031).
Although there was a decrease in fluoroscopy and left atrium instrumentation time with the use of OIC at higher power, this setting was associated with increased cardiovascular and gastrointestinal complications.
我们试图测试使用开放式灌注导管（OIC）进行导管消融与标准导管用于肺静脉前庭隔离的效果对比。
开放式灌注导管具有在不提高导管尖端温度的情况下输送更大功率的优势，这使得能够形成更深、更宽的损伤灶，且导管上不会形成凝块。
使用8毫米导管（8MC）或开放式灌注导管进行导管消融。患者被随机分为3组：8MC组；OIC - 1组，即具有较高峰值功率（50瓦）的开放式灌注导管组；OIC - 2组，即具有较低峰值功率（35瓦）的开放式灌注导管组。
共有180例患者被随机分配至3种治疗策略组。所有患者均实现了肺静脉前庭隔离。与OIC - 2组相比，8MC组和OIC - 1组的无房颤发生率显著更高（分别为78%、82%和68%，p = 0.043）。与OIC - 2组和8MC组相比，OIC - 1组的透视时间更短（分别为28±1分钟、53±2分钟和46±2分钟，p = 0.001）。与OIC - 2组和8MC组相比，OIC - 1组的平均左心房操作时间更短（分别为59±3分钟、90±5分钟和88±4分钟，p = 0.001）。然而，OIC - 1组的“爆裂声”发生率更高（分别为100%、0%、0%，p < 0.001），心包积液发生率也更高（分别为20%、0%、0%，p < 0.001），胃肠道不适发生率也更高（OIC - 1组为17%，8MC组为3%，OIC - 2组为5%，p = 0.031）。
尽管使用较高功率的开放式灌注导管可减少透视和左心房操作时间，但这种设置与心血管和胃肠道并发症增加相关。
