Department of Cardiology, Antwerp Cardiovascular Institute Middelheim, Antwerpen, Belgium.
J Cardiovasc Electrophysiol. 2013 Mar;24(3):290-6. doi: 10.1111/jce.12021. Epub 2012 Oct 30.
The objective was to study the impact of radiofrequency (RF) characteristics on acute pulmonary vein reconnection (PVR) and outcome after PVAC ablation. PVI with additional ablation of PVR (PVI + PVR) was compared to PVI-only.
In 40 consecutive patients, after PVAC-guided PVI, adenosine and a 1-hour waiting time were used to unmask and ablate acute PVR (PVI + PVR group). RF-characteristics and 1-year AF freedom were compared post hoc to 40 clinically matched patients undergoing PVI only (PVI-only group). Custom-made software was used to assess RF characteristics of the PVAC applications needed to obtain baseline PVI.
There was no difference in clinical characteristics or baseline RF-profile between both groups. Acute PVR was observed and ablated in 38 of 160 veins (24%). AF-freedom after PVI + PVR was higher than PVI (85% vs 65%, P < 0.05). Within the PVI group, comparing patients with and without AF-recurrence, the percentage of PVAC applications with high T° (>48°) but low power (<3W) was higher (28 ± 18% vs 11 ± 11%, P < 0.0001). Within the PVI + PVR group, when comparing PVs with and without PVR, the percentage of low power/high T° PVAC applications was also higher (27 ± 13% vs 13 ± 15%, P < 0.0001).
(1) After PVAC ablation, 24% of PVs exhibit acute reconnection. Additional ablation of reconnection improves clinical outcome. (2) Acute reconnection as well as clinical recurrence of AF are characterized by PVAC ablation with a considerable number of applications with high temperature but low power. (3) If PV isolation is obtained with low power applications, a consistent use of both adenosine and waiting time is required.
研究射频（RF）特性对急性肺静脉再连接（PVR）和 PVAC 消融后结果的影响。比较了附加 PVR 消融的 PVI（PVI+PVR）与单纯 PVI。
在 40 例连续患者中，在 PVAC 引导的 PVI 后，使用腺苷和 1 小时等待时间来揭示和消融急性 PVR（PVI+PVR 组）。事后比较了 40 例临床匹配的单纯 PVI 患者（单纯 PVI 组）的 RF 特性和 1 年 AF 自由。使用定制软件评估获得基线 PVI 所需的 PVAC 应用的 RF 特性。
两组间临床特征和基线 RF 特征无差异。在 160 条静脉中有 38 条（24%）观察到并消融了急性 PVR。PVI+PVR 后 AF 自由率高于 PVI（85%比 65%，P<0.05）。在 PVI 组中，比较有和无 AF 复发的患者，高 T°（>48°）但低功率（<3W）的 PVAC 应用百分比更高（28±18%比 11±11%，P<0.0001）。在 PVI+PVR 组中，比较有和无 PVR 的 PV 时，低功率/高 T°PVAC 应用的百分比也更高（27±13%比 13±15%，P<0.0001）。
（1）在 PVAC 消融后，24%的 PV 出现急性再连接。附加的再连接消融可改善临床结果。（2）急性再连接和 AF 的临床复发特征是 PVAC 消融时应用大量高温度但低功率的应用。（3）如果用低功率应用获得 PV 隔离，则需要一致地使用腺苷和等待时间。
