Dorwarth Uwe, Schmidt Martin, Wankerl Michael, Krieg Juergen, Straube Florian, Hoffmann Ellen
Department of Cardiology an Intensive Care Medicine, Heart Center Munich-Bogenhausen, Klinikum Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany.
J Interv Card Electrophysiol. 2011 Dec;32(3):205-11. doi: 10.1007/s10840-011-9585-x. Epub 2011 May 19.
Cryoballoon technique is an innovative alternative to radiofrequency ablation for atrial fibrillation (AF). However, with current cryoballoon application techniques, the operator has no access to electrical information for 300 s during the freezing cycle.
The objective of this study is to investigate the novel approach of real-time monitoring of pulmonary vein (PV) potentials throughout freezing using a circular mapping catheter introduced into the central lumen of the cryoballoon catheter.
Patients had paroxysmal or persistent AF. Standard balloon catheters (23 or 28 mm diameter, 10.5 F shaft) were used. A coaxial mapping catheter (shaft diameter 0.9 mm; 15 mm loop with six electrodes) was advanced through the lumen of the cryoballoon catheter, replacing the guide wire. The primary procedural end point was successful PV isolation and real-time PV potential recording. Secondary end points were procedural data, complications, and the time to successful PV isolation.
In 141 consecutively enrolled patients, balloon positioning and ablation were successful in 439/568 veins (77%). Real-time recording of PV conduction during the freeze cycle was possible in 235/568 PVs (41%). Main reasons for failure to obtain real-time PV recordings were a distal position of the circular mapping catheter or insufficient catheter-vessel wall contact during ablation. A cutoff value of 83 s to PV isolation was predictive of stable procedural PV isolation without reconduction. One minor hemoptysis was observed possibly related to the mapping catheter.
This study, the largest to date, showed that real-time monitoring of PV conduction during cryoballoon freezing can be safely performed with a circular mapping catheter. A cutoff time of 83 s to PV isolation was predictive of sustained procedural PV isolation success without reconduction.
冷冻球囊技术是心房颤动（AF）射频消融的一种创新替代方法。然而，采用当前的冷冻球囊应用技术时，在冷冻周期的300秒内操作者无法获取电信息。
本研究的目的是探讨一种新方法，即通过引入冷冻球囊导管中心腔的环形标测导管在整个冷冻过程中实时监测肺静脉（PV）电位。
患者患有阵发性或持续性AF。使用标准球囊导管（直径23或28mm，10.5F导管鞘）。将同轴标测导管（导管鞘直径0.9mm；带有六个电极的15mm环）通过冷冻球囊导管的腔推进，取代导丝。主要手术终点是成功实现PV隔离并实时记录PV电位。次要终点是手术数据、并发症以及成功实现PV隔离的时间。
在连续纳入的141例患者中，球囊定位和消融在568条静脉中的439条成功（77%）。在568条PV中的235条（41%）能够在冷冻周期期间实时记录PV传导。未能获得实时PV记录的主要原因是环形标测导管位置过远或消融期间导管与血管壁接触不足。至PV隔离的83秒截断值可预测手术中PV隔离稳定且无再传导。观察到1例轻度咯血，可能与标测导管有关。
这项迄今为止规模最大的研究表明，使用环形标测导管可在冷冻球囊冷冻期间安全地实时监测PV传导。至PV隔离的83秒截断时间可预测手术中PV隔离持续成功且无再传导。
