Schade Anja, Schumacher Burghard, Dietrich Johannes W, Langbein Anke, Groschup Guido, Koucky Katrin, Krug Joachim, Stahl Carsten, Müller Patrick, Nentwich Karin, Roos Markus, Deneke Thomas
The Heart Center Bad Neustadt/Saale, Clinic for Electrophysiology, Ruhr-University Bochum, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Germany,
J Interv Card Electrophysiol. 2015 Jan;42(1):33-41. doi: 10.1007/s10840-014-9957-0. Epub 2014 Dec 13.
Cryoballoon isolation of the pulmonary veins (PVI) is an effective and safe method in the treatment of patients with paroxysmal atrial fibrillation (PAF). The circular mapping catheter Achieve® (Medtronic Inc., Minneapolis, USA) can be introduced into the pulmonary vein (PV) through the inner lumen of the balloon catheter, allowing online mapping of the PV electrograms during ablation. We prospectively compared the accuracy of this catheter in both available sizes to a standard circular mapping catheter (SCMC) in order to determine bidirectional PV block.
Patients with symptomatic PAF underwent cryoballoon ablation using either the Achieve® 15-mm catheter (group 1, 15 patients) or the Achieve® 20 mm (group 2, 15 patients). PV potentials were recorded using Achieve® before, during, and after ablation, and exit block was obtained by pacing from inside the PV. Accuracy of PV potential detection was controlled by a SCMC before and after ablation.
Rate of PV which could be isolated exclusively using the Achieve® as guidewire was 98 % (59/60) in group 1 and 93 % (57/60) in group 2. Online signal recording during ablation was possible in 40 and 60 % of PV (p = 0.037), respectively. Final Achieve® diagnosis was accurate in 55/60 (92 %) of the PVs and 12/15 (80 %) of patients in group 1 and 60/60 (100 %) of PV and 15/15 (100 %) of patients in group 2.
Stand-alone mapping using Achieve® 15 mm resulted in a significant lack of diagnostic accuracy. Achieve® 20 mm provided excellent diagnostic accuracy comparable to a SCMC and should be preferentially used.
冷冻球囊肺静脉隔离术（PVI）是治疗阵发性心房颤动（PAF）患者的一种有效且安全的方法。环形标测导管Achieve®（美敦力公司，美国明尼阿波利斯）可通过球囊导管的内腔插入肺静脉（PV），从而在消融过程中对PV电图进行在线标测。我们前瞻性地比较了这两种可用尺寸的导管与标准环形标测导管（SCMC）在确定双向PV阻滞方面的准确性。
有症状的PAF患者接受冷冻球囊消融，使用Achieve® 15毫米导管（第1组，15例患者）或Achieve® 20毫米导管（第2组，15例患者）。在消融前、消融期间和消融后使用Achieve®记录PV电位，并通过在PV内部起搏获得出口阻滞。在消融前后，用SCMC控制PV电位检测的准确性。
仅以Achieve®作为导丝可隔离的PV率在第1组为98%（59/60），在第2组为93%（57/60）。消融期间分别有40%和60%的PV可进行在线信号记录（p = 0.037）。第1组中，最终Achieve®诊断在55/60（92%）的PV和12/15（80%）的患者中准确，第2组中在60/60（100%）的PV和15/15（100%）的患者中准确。
单独使用15毫米的Achieve®进行标测导致诊断准确性显著不足。20毫米的Achieve®提供了与SCMC相当的出色诊断准确性，应优先使用。
