Meissner Axel, Trappe H-J, Butz T, van Bracht M, Maagh P, Plehn G
Medizinische Klinik II, Abteilung für Kardiologie und Angiologie, Ruhr-Universität Bochum, Herne.
Dtsch Med Wochenschr. 2009 Sep;134(38):1861-7. doi: 10.1055/s-0029-1237524. Epub 2009 Sep 10.
Interventional therapy of atrial fibrillation (AF) is often associated with long examination- and fluoroscopy times. The use of mapping catheters in addition to the ablation catheter requires multiple transseptal sheets for left atrial access. The HDMA was introduced in 2007 for the the segmental and circumferentil ablation of paroxysmal atrial fibrillation. In small experimental study groups the new catheter system was validated for its electrophysiological properties. The purpose of this prospective study was to evaluate feasibility and safety of pulmonary vein (PV) isolation using the High Density Mesh Ablator (HDMA), a novel single, expandable electrode catheter for both mapping and radiofrequency (RF) delivery at the left atrium/PV junctions.
40 patients with highly symptomatic paroxysmal AF (PAF, 23/57,5 %) and persistent AF (CAF, 17/42,5 %) were studied. PV isolation via the HDMA was performed using a customized pulsed RF energy delivery program (target temperature 55 - 60 degrees, power 70 - 100 Watt, 600 - 1000 seconds RF application time/PV).
All 158 PV in 40 patients could be mapped and ablated by the HDMA. Segmental PV isolation was achieved with a mean of 3,75 +/- 1,9 RF applications for a mean of 715 +/- 375 sec. Entrance conduction block was obtained in 93,5 % of all PV. Mean total procedure and fluoroscopy time was 152 +/- 34 min and 29 +/- 10 min respectively. None of the patients experienced severe complications. After 3 month 78 % of the patients with PAF and 41 % with CAF respectively were free of AF.
In this first study of PV isolation using the HDMA, our findings suggest that this method is feasible, and yields good primary success rates. Due to single transseptal access the HDMA simplifies the complex procedure of AF ablation, favorably impacting procedure and fluoroscopy times.
心房颤动（AF）的介入治疗常常伴随着较长的检查和透视时间。除了消融导管外，使用标测导管还需要多张经间隔片来进入左心房。高密度网状消融器（HDMA）于2007年被引入用于阵发性心房颤动的节段性和环周消融。在小型实验研究组中，新的导管系统在电生理特性方面得到了验证。这项前瞻性研究的目的是评估使用高密度网状消融器（HDMA）进行肺静脉（PV）隔离的可行性和安全性，HDMA是一种新型的单根、可扩张电极导管，用于在左心房/肺静脉交界处进行标测和射频（RF）消融。
研究了40例症状严重的阵发性房颤（PAF，23例/57.5%）和持续性房颤（CAF，17例/42.5%）患者。通过HDMA进行肺静脉隔离时，使用了定制的脉冲射频能量输送程序（目标温度55 - 60度，功率70 - 100瓦，每个肺静脉射频应用时间600 - 1000秒）。
40例患者的158条肺静脉均能通过HDMA进行标测和消融。节段性肺静脉隔离平均进行3.75 +/- 1.9次射频应用，平均时间为715 +/- 375秒。93.5%的肺静脉实现了入口传导阻滞。平均总手术时间和透视时间分别为152 +/- 34分钟和29 +/- 10分钟。所有患者均未发生严重并发症。3个月后，阵发性房颤患者和持续性房颤患者分别有78%和41%无房颤发作。
在这项首次使用HDMA进行肺静脉隔离的研究中，我们的研究结果表明该方法可行，且初次成功率良好。由于只需单次经间隔穿刺，HDMA简化了房颤消融的复杂操作，对手术时间和透视时间产生了有利影响。
