Sohns Christian, Bergau Leonard, Seegers Joachim, Lüthje Lars, Vollmann Dirk, Zabel Markus
Division of Clinical Electrophysiology, Department of Cardiology and Pneumology, Heart Center, Georg-August-University of Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany,
J Interv Card Electrophysiol. 2014 Oct;41(1):75-82. doi: 10.1007/s10840-014-9915-x. Epub 2014 Jun 19.
In ablation of atrial fibrillation, the single-ring method aims for isolation of the posterior wall of the left atrium (LA) including the pulmonary veins (PVs) but avoiding posterior LA lesions. The aim of this randomized prospective study was to evaluate safety and efficacy of remote magnetic navigation (RMN)-guided single-ring ablation strategy as compared to standard RMN-guided circumferential PV ablation (PVA).
Eighty consecutive patients undergoing PVA were enrolled prospectively and randomized equally into two study groups. RMN using the Stereotaxis system and open-irrigated 3.5-mm ablation catheters were used with a 3D mapping system in all procedures. Forty patients underwent RMN-guided single-ring ablation, and 40 patients received RMN-guided circumferential PVA.
In the circumferential group, 3.3 ± 1.1 PVs were successfully isolated at the end of the procedure as compared to 3.1 ± 1.3 in the single-ring (box) group (p=0.38). All patients in the box group required additional posterior lesions in order to achieve electrical isolation of the PVs. Single-ring ablation was associated with longer procedure duration (p=0.01) and ablation time (p=0.001). After a single procedure, the proportion of patients free of any atrial tachycardia (AT)/atrial fibrillation (AF) episode at 12-month follow-up was 57 % in the box group and 58 % in the circ group. Using RMN, only minor complications have been observed.
RMN-guided single-ring PVA provides comparable acute and long-term success rates as compared to RMN-guided circumferential PVA but requires additional posterior lesions to achieve PV isolation and increased procedure and ablation time. Procedural complication rates are low when using RMN.
在心房颤动消融术中，单环法旨在隔离包括肺静脉（PVs）在内的左心房（LA）后壁，但避免左心房后壁损伤。本随机前瞻性研究的目的是评估与标准的遥控磁导航（RMN）引导下的肺静脉环形消融术（PVA）相比，遥控磁导航引导下单环消融策略的安全性和有效性。
连续80例接受PVA的患者被前瞻性纳入研究并随机分为两个研究组。在所有手术过程中，均使用带有3D标测系统的Stereotaxis系统和开放式灌注3.5毫米消融导管进行RMN。40例患者接受RMN引导下单环消融，40例患者接受RMN引导下肺静脉环形PVA。
在环形组中，手术结束时成功隔离的肺静脉数量为3.3±1.1条，而单环（盒状）组为3.1±1.3条（p=0.38）。盒状组的所有患者都需要额外的后壁损伤才能实现肺静脉的电隔离。单环消融与更长的手术时间（p=0.01）和消融时间（p=0.001）相关。单次手术后，在12个月随访时无任何房性心动过速（AT）/心房颤动（AF）发作的患者比例，盒状组为57%，环形组为58%。使用RMN时，仅观察到轻微并发症。
与RMN引导下的肺静脉环形PVA相比，RMN引导下单环PVA提供了相当的急性和长期成功率，但需要额外的后壁损伤来实现肺静脉隔离，并增加了手术和消融时间。使用RMN时手术并发症发生率较低。
