Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
Europace. 2010 Apr;12(4):502-7. doi: 10.1093/europace/euq023. Epub 2010 Feb 25.
A novel multi-electrode pulmonary vein ablation catheter (PVAC) combining circular mapping and duty-cycled multi-electrode radiofrequency (RF) energy delivery has been developed to map and isolate the pulmonary veins (PVs). The aim of this study was to assess the efficacy of multi-electrode RF ablation using the PVAC device.
A total of 102 consecutive patients, age 57.9 +/- 9.6 years, with paroxysmal or persistent drug refractory atrial fibrillation (AF) were referred for ablation. All patients had documented AF episodes with an AF duration of 9.3 +/- 7.5 years (range 1.5-25). The mean total procedure time was 139.30 +/- 37.72 (median 135, range 115-172). The mean fluoroscopy time required for PVAC ablation was 17 +/- 12 min (median 16, range 12-33) and the total fluoroscopy time was 32.1 +/- 11.3 min (median 29, range 25-39). The mean multi-electrode RF ablation time required to achieve complete PV isolation was 31 +/- 6.7 min (range 16-51). In eight patients with persistent AF, additional ablations were performed to defragment septal and posterior part of the left atrium. In five patients additional RF ablations using conventional catheters were necessary. After multi-electrode duty-cycled RF ablation, 62 of 102 (60.8%) patients were in sustained sinus rhythm without anti-arrhythmic drugs. The mean follow-up duration was 12.2 +/- 3.9 months (range 6-15).
This novel multi-electrode ablation technique can be used for PV isolation and left atrium ablation with a relatively low medium-term success rate after the first ablation of approximately 61%. Larger studies with longer follow-up are required to evaluate the efficacy and whether multi-electrode RF ablation is associated with a different complication rate compared with standard PV isolation.
开发了一种新型多电极肺静脉消融导管（PVAC），结合环形标测和周期性多电极射频（RF）能量传递，用于标测和隔离肺静脉（PVs）。本研究旨在评估使用 PVAC 装置进行多电极 RF 消融的疗效。
共纳入 102 例连续患者，年龄 57.9±9.6 岁，阵发性或持续性药物难治性心房颤动（AF）。所有患者均有记录的 AF 发作，AF 持续时间为 9.3±7.5 年（范围 1.5-25）。总手术时间为 139.30±37.72 分钟（中位数 135 分钟，范围 115-172 分钟）。PVAC 消融所需的平均透视时间为 17±12 分钟（中位数 16 分钟，范围 12-33 分钟），总透视时间为 32.1±11.3 分钟（中位数 29 分钟，范围 25-39 分钟）。实现完全 PV 隔离所需的多电极 RF 消融平均时间为 31±6.7 分钟（范围 16-51 分钟）。在 8 例持续性 AF 患者中，进行了额外的消融以碎裂左心房的间隔和后部分。在 5 例患者中，需要使用常规导管进行额外的 RF 消融。多电极循环 RF 消融后，102 例患者中有 62 例（60.8%）在未服用抗心律失常药物的情况下持续窦性心律。平均随访时间为 12.2±3.9 个月（范围 6-15 个月）。
这种新型多电极消融技术可用于 PV 隔离和左心房消融，首次消融后约 61%的患者中具有相对较低的中期成功率。需要更大规模的研究和更长时间的随访，以评估该技术的疗效以及多电极 RF 消融是否与标准 PV 隔离相比具有不同的并发症发生率。
