Kimura Masaomi, Sasaki Shingo, Owada Shingen, Horiuchi Daisuke, Sasaki Kenichi, Itoh Taihei, Ishida Yuji, Kinjo Takahiko, Tomita Hirofumi, Okumura Ken
Department of Cardiology.
Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Heart Rhythm. 2014 Jun;11(6):984-91. doi: 10.1016/j.hrthm.2014.03.019. Epub 2014 Mar 18.
Contact force (CF) monitoring could be useful in accomplishing circumferential pulmonary vein (PV) isolation (CPVI) for atrial fibrillation (AF).
The purpose of this study was to compare procedure parameters and outcomes between CF-guided and non-guided CPVI.
Thirty-eight consecutive AF patients (mean age 60 ± 11 years, 28 paroxysmal AF) undergoing CPVI were randomized to non-CF-guided (n = 19) and CF-guided (n = 19) groups. CPVI was performed with the ThermoCool SmartTouch catheter in both groups. The end-point was bidirectional block between the left atrium (LA) and PV. In the CF group, CF was kept between 10 and 20 g during CPVI, whereas in the non-CF group, all CF information was blanked. Radiofrequency energy at 30 W in the anterior and 25 W in the posterior LA wall was applied for 20-25 seconds at each point.
CPVI was successfully accomplished without any major complications in both groups. Mean CF in the non-CF and CF groups were 5.9 ± 4.5 g and 11.1 ± 4.3 g, respectively, for left-side CPVI, and 9.8 ± 6.6 g and 12.1 ± 4.8 g, respectively, for right-side CPVI (both P <.001). The procedure and fluoroscopy times for CPVI in the non-CF and CF groups were 96 ± 39 minutes and 59 ± 16 minutes, respectively (P <.001), and 22 ± 63 seconds and 9 ± 20 seconds (P = NS), respectively. Total number of residual conduction gaps was 6.3 ± 3.0 in the non-CF group and 2.8 ± 1.9 in the CF group (P <.001). During 6-month follow-up, 84.2% of patients in the non-CF group and 94.7% in the CF group were free from any atrial tachyarrhythmias (P = .34).
CF-guided CPVI is effective in reducing procedure time and additional touch-up ablation and may improve long-term outcome.
接触力（CF）监测可能有助于完成心房颤动（AF）的环肺静脉（PV）隔离（CPVI）。
本研究旨在比较CF引导和非引导下CPVI的手术参数及结果。
38例连续接受CPVI的AF患者（平均年龄60±11岁，28例阵发性AF）被随机分为非CF引导组（n = 19）和CF引导组（n = 19）。两组均使用ThermoCool SmartTouch导管进行CPVI。终点为左心房（LA）与PV之间的双向阻滞。在CF组，CPVI期间CF保持在10至20克之间，而在非CF组，所有CF信息均被屏蔽。在LA前壁施加30W、后壁施加25W的射频能量，每个点持续20 - 25秒。
两组均成功完成CPVI，无任何重大并发症。非CF组和CF组左侧CPVI的平均CF分别为5.9±4.5克和11.1±4.3克，右侧CPVI分别为9.8±6.6克和12.1±4.8克（均P<.001）。非CF组和CF组CPVI的手术时间和透视时间分别为96±39分钟和59±16分钟（P<.001），以及22±63秒和9±20秒（P =无显著差异）。非CF组残余传导间隙总数为6.3±3.0，CF组为2.8±1.9（P<.001）。在6个月的随访期间，非CF组84.2%的患者和CF组94.7%的患者无任何房性快速性心律失常（P =.34）。
CF引导下的CPVI可有效缩短手术时间并减少额外的补充消融，可能改善长期预后。
