Département de Rythmologie, Clinique Pasteur, 45 Avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
European Georges Pompidou Hospital, Paris, France.
Europace. 2015 Jan;17(1):56-63. doi: 10.1093/europace/euu218. Epub 2014 Oct 3.
Real-time measurement of contact force (CF) during catheter ablation of atrial fibrillation (AF) has been recently suggested to potentially impact procedural outcome. However, the role of CF intensity on mid-term results using the SmartTouch™ catheter has not been investigated so far.
Pulmonary vein isolation (PVI) using the SmartTouch™ catheter was performed in 100 eligible patients (age 62 ± 8; 79% men) undergoing a first procedure of paroxysmal AF catheter ablation. Continuous CF monitoring during catheter ablation allowed calculation of mean CF per patient. Patients were dichotomized into high CF (≥22 g, upper quartile) and low CF (<22 g, remaining) and enroled in a standardized follow-up programme (after a 3-month blanking period), free from antiarrhythmic therapy, with regular evaluations including 24 h Holter recordings at 1, 3, 6, 9, 12, 18, and 24 months. Atrial fibrillation relapse was defined as any symptomatic or asymptomatic atrial arrhythmia lasting >30 s. The average CF among all procedures was 19.6 ± 3.7 g. Though complete PVI was eventually achieved in all cases in both groups, success using an exclusively anatomical approach was higher in the high CF group (92.0 vs. 72.0%; P = 0.04). During a mean follow-up of 19 ± 5 months, a lower incidence of AF relapse was observed in higher CF patients (4.0 vs. 20.0%; log rank P = 0.04). Pericardial tamponade occurred in one patient in the higher CF group. No thromboembolism or procedure-associated deaths were observed.
Higher values of CF overall during antral PVI appear to be associated with a higher likelihood of sinus rhythm maintenance without significantly increasing the complication rate.
最近有人提出，在房颤（AF）导管消融过程中实时测量接触力（CF）可能会影响手术结果。然而，迄今为止，还没有研究使用 SmartTouch™导管的 CF 强度对中期结果的影响。
对 100 例适合接受阵发性 AF 导管消融的首次导管消融的患者（年龄 62±8 岁；79%为男性）进行了肺静脉隔离（PVI）。在导管消融过程中进行连续 CF 监测，可计算每位患者的平均 CF。将患者分为高 CF（≥22g，四分位上）和低 CF（<22g，其余）两组，并纳入标准化随访计划（空白期 3 个月后），不使用抗心律失常治疗，定期评估，包括 1、3、6、9、12、18 和 24 个月时的 24 小时 Holter 记录。房颤复发定义为任何持续 >30s 的有症状或无症状房性心律失常。所有手术的平均 CF 为 19.6±3.7g。尽管在两组中所有病例最终均实现了完全 PVI，但在高 CF 组中，单纯解剖学方法的成功率更高（92.0%比 72.0%；P=0.04）。在平均 19±5 个月的随访中，高 CF 患者的房颤复发率较低（4.0%比 20.0%；对数秩 P=0.04）。在高 CF 组中有 1 例发生心包填塞。无血栓栓塞或与手术相关的死亡。
总体而言，在心房 PVI 期间 CF 值较高似乎与维持窦性心律的可能性增加相关，而不会显著增加并发症发生率。
