Beukema Rypko J, Elvan Arif, Smit Jaap Jan J, Delnoy Peter Paul H M, Misier Anand R Ramdat, Reddy Vivek
Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011, JW, Zwolle, The Netherlands.
J Interv Card Electrophysiol. 2012 Aug;34(2):143-52. doi: 10.1007/s10840-011-9653-2. Epub 2012 Feb 23.
For patients with symptomatic atrial fibrillation (AF), a curvilinear multi-electrode ablation (MEA) catheter has been reported to be successful to achieve pulmonary vein (PV) isolation. However, this approach has not been compared prospectively with conventional PV isolation (CPVI) using a standard circular mapping catheter and 3D electro-anatomic mapping. In this prospective non-randomized study, we compared the efficacy of these two techniques.
Of 185 consecutive patients, age 54.6 ± 10.1 years, with symptomatic paroxysmal AF (PAF), 96 patients underwent PV isolation by CPVI and 89 patients underwent MEA to isolate the PVs. CPVI was performed by encircling the left- and right-sided PVs. During MEA, the PV ablation catheter (Medtronic, USA) was used to isolate PVs with duty-cycled radiofrequency energy.
The mean procedure time was 171.73 ± 52.87 min for CPVI and 133.25 ± 37.99 min for MEA, respectively (P < 0.001). The mean fluoroscopy time was 31.07 ± 14.97 for CPVI and 30.07 ± 11.45 min for MEA (P = 0.651). At 12 months, 80% of patients who underwent CPVI and 82% of patients who underwent MEA were free of symptomatic PAF off antiarrhythmic drug therapy (P = 0.989). Among the variables of age, gender, duration and frequency of PAF, left ventricular ejection fraction, left atrial size, structural heart disease, and the ablation technique, only an increased left atrial size was an independent predictor of recurrent PAF. Left atrial flutter occurred after CPVI in two patients and after MEA ablation in three patients.
In patients undergoing catheter ablation for PAF, MEA and CPVI proved equally efficacious.
对于有症状的心房颤动（AF）患者，据报道，曲线多电极消融（MEA）导管成功实现了肺静脉（PV）隔离。然而，该方法尚未与使用标准环形标测导管和三维电解剖标测的传统PV隔离（CPVI）进行前瞻性比较。在这项前瞻性非随机研究中，我们比较了这两种技术的疗效。
在185例年龄为54.6±10.1岁的有症状阵发性AF（PAF）连续患者中，96例患者通过CPVI进行PV隔离，89例患者接受MEA以隔离PV。CPVI通过环绕左右两侧的PV进行。在MEA期间，使用PV消融导管（美国美敦力公司）通过占空比射频能量隔离PV。
CPVI的平均手术时间分别为171.73±52.87分钟，MEA为133.25±37.99分钟（P<0.001）。CPVI的平均透视时间为31.07±14.97分钟，MEA为30.07±11.45分钟（P = 0.651）。在12个月时，接受CPVI的患者中有80%和接受MEA的患者中有82%在停用抗心律失常药物治疗后无有症状的PAF（P = 0.989）。在年龄、性别、PAF的持续时间和频率、左心室射血分数、左心房大小、结构性心脏病以及消融技术等变量中，只有左心房大小增加是复发性PAF的独立预测因素。CPVI后有2例患者发生左心房扑动，MEA消融后有3例患者发生左心房扑动。
在接受PAF导管消融的患者中，MEA和CPVI证明同样有效。
