Yokokawa Miki, Bhandari Anil K, Tada Hiroshi, Suzuki Atsushi, Kawamura Mitsuharu, Ho Ivan, Cannom David S
Division of Cardiology, Good Samaritan Hospital, Los Angeles, California 90017, USA.
Pacing Clin Electrophysiol. 2011 Jan;34(1):15-22. doi: 10.1111/j.1540-8159.2010.02944.x. Epub 2010 Oct 28.
The relationship between the applied techniques and clinical outcomes after radiofrequency (RF) ablation of atrial fibrillation (AF) remains unclear. We compared the results of ablation by RF delivered via a point-by-point versus catheter dragging technique for the treatment of AF.
This study included 66 patients with drug-refractory AF who underwent circumferential pulmonary vein (PV) ablation. A point-by-point technique was used in 35 (53%) patients (Group I), and catheter dragging technique in the remaining 31 (47%) patients (Group II). If AF persisted or remained inducible after the PV isolation, additional ablation of complex fractionated atrial electrograms and linear ablation were performed.
Significantly, fewer RF applications were delivered in Group II than in Group I. The total RF energy duration delivered was comparable between the two groups (P = 0.55). However, the total energy of RF deliveries was significantly greater in Group II than in Group I (P = 0.02). Despite a longer fluoroscopic exposure time (P = 0.01), the total procedural duration was significantly shorter in Group II than in Group I (P = 0.005). Within 3 months after a single ablation procedure, 24 patients (69%) in Group I versus 13 patients (42%) in Group II had ≥1 recurrence(s) of atrial tachyarrhythmias (P = 0.03). A multivariate analysis showed that a point-by-point ablation was the only independent predictor of early atrial tachyarrhythmia recurrences.
The catheter dragging technique for ablation of AF was associated with a lower early recurrence rate of atrial tachyarrhythmias than the point-by-point technique.
房颤（AF）射频（RF）消融术后应用技术与临床结局之间的关系仍不明确。我们比较了通过逐点与导管拖动技术进行RF消融治疗AF的结果。
本研究纳入66例药物难治性AF患者，均接受了环肺静脉（PV）消融。35例（53%）患者采用逐点技术（I组），其余31例（47%）患者采用导管拖动技术（II组）。如果PV隔离后AF持续存在或仍可诱发，则进行碎裂心房电图的额外消融和线性消融。
显著地，II组的RF应用次数少于I组。两组的总RF能量持续时间相当（P = 0.55）。然而，II组的RF总能量显著高于I组（P = 0.02）。尽管透视时间更长（P = 0.01），但II组的总手术时间显著短于I组（P = 0.005）。在单次消融术后3个月内，I组24例（69%）患者与II组13例（42%）患者发生≥1次房性快速心律失常复发（P = 0.03）。多变量分析显示逐点消融是房性快速心律失常早期复发的唯一独立预测因素。
与逐点技术相比，AF导管拖动消融技术与房性快速心律失常的早期复发率较低相关。
