Deneke Thomas, Müller Patrick, Halbfaß Philipp, Szöllösi Atilla, Roos Markus, Krug Joachim, Fochler Franziska, Schade Anja, Schmitt Rainer, Christopoulos Georgios, Mügge Andreas, Nentwich Karin
Heart Center Bad Neustadt, Bad Neustadt, Germany.
Ruhr-University Bochum, Bochum, Germany.
J Cardiovasc Electrophysiol. 2015 Oct;26(10):1063-8. doi: 10.1111/jce.12736. Epub 2015 Sep 1.
Single-shot ablation devices for pulmonary vein isolation (PVI) in patients with symptomatic atrial fibrillation (AF) have been increasingly used in clinical practice.
A novel mapping-system integrated irrigated multipolar circular ablation catheter (nMARQ) has been introduced for PVI but data on larger patient cohorts on acute safety and efficacy are lacking.
A total of 145 consecutive patients undergoing AF ablation treated with the nMARQ underwent endoscopic evaluation of esophageal thermal damage (EDEL) and brain MRI for detection of silent cerebral events (SCE). During the course of our experience different modifications of the ablation strategy, including energy delivery at the left atrial posterior wall, were evaluated.
Effective PVI was achieved in 99% of all PVs during a mean procedure-duration of 115 (±36) minutes and ablation-duration of 18 (±8) minutes. Acute major complications occurred in 3 patients (2.1%) and asymptomatic complications like SCE in 26% and EDEL in 21%. There was a significant reduction in EDEL when not using a thermal esophageal probe (0% vs. 28%, P < 0.0001). Ablation under oral anticoagulation led to lower SCE incidences compared to interrupted anticoagulation regimen (15% vs. 31%, P = 0.7). Out of 65 patients with completed 12-month follow-up, 43 (66%) were in stable sinus rhythm.
PVI using the nMARQ is safe and effective in patients with symptomatic AF. Not using an esophageal temperature probe during ablation has relevantly reduced the incidence of EDEL. Ablations under continued oral anticoagulation have reduced incidence of SCE. Further studies on long-term efficacy are needed.
用于有症状心房颤动（AF）患者肺静脉隔离（PVI）的单次消融装置在临床实践中越来越多地被使用。
一种新型的集成映射系统的灌注射频多极环形消融导管（nMARQ）已被引入用于PVI，但缺乏关于更大患者队列的急性安全性和有效性的数据。
总共145例连续接受nMARQ治疗的AF消融患者接受了食管热损伤（EDEL）的内镜评估和脑部MRI检查以检测无症状脑事件（SCE）。在我们的经验过程中，评估了消融策略的不同修改，包括左心房后壁的能量输送。
在平均手术时间115（±36）分钟和消融时间18（±8）分钟内，99%的肺静脉实现了有效的PVI。3例患者（2.1%）发生急性主要并发症，26%发生如SCE等无症状并发症，21%发生EDEL。不使用食管热探头时EDEL显著降低（0%对28%，P<0.0001）。与中断抗凝方案相比，口服抗凝下的消融导致SCE发生率更低（15%对31%，P = 0.7）。在65例完成12个月随访的患者中，43例（66%）处于稳定窦性心律。
使用nMARQ进行PVI对有症状AF患者是安全有效的。消融期间不使用食管温度探头已显著降低EDEL的发生率。持续口服抗凝下的消融降低了SCE的发生率。需要进一步研究长期疗效。
