Gould Paul A, Booth Cameron, Dauber Kieran, Ng Kevin, Claughton Andrew, Kaye Gerald C
University of Queensland, School of Medicine, Queensland, Australia.
Department of Cardiology, Princess Alexandra Hospital, Queensland, Australia.
J Cardiovasc Electrophysiol. 2016 Dec;27(12):1429-1436. doi: 10.1111/jce.13087. Epub 2016 Oct 25.
This study sought to investigate specific contact force (CF) parameters to guide cavotricuspid isthmus (CTI) ablation and compare the outcome with a historical control cohort.
Patients (30) undergoing CTI ablation were enrolled prospectively in the Study cohort and compared with a retrospective Control cohort of 30 patients. Ablation in the Study cohort was performed using CF parameters >10 g and <40 g and a Force Time Integral (FTI) of 800 ± 10 g. The Control cohort underwent traditionally guided CTI ablation. Traditional parameters (electrogram and impedance change) were assessed in both cohorts. All ablations regardless of achieving targets were included in data analysis. Bidirectional CTI block was achieved in all of the Study and 27 of the Control cohort. Atrial flutter recurred in 3 (10%) patients (follow-up 564 ± 212 days) in the study cohort and in 3 (10%) patients (follow-up 804 ± 540 days) in the Control cohort. There were no major complications in either cohort. Traditional parameters correlated poorly with CF parameters. In the Study cohort, flutter recurrence was associated with significantly lower FTI and ablation duration, but was not associated with total average CF.
CTI ablation can be safely performed using CF parameters guiding ablation, with similar long-term results to a historical ablation control group. Potentially CF parameters may provide adjunctive information to enable a more efficient CTI ablation. Further research is required to confirm this.
本研究旨在探究特定接触力（CF）参数以指导三尖瓣峡部（CTI）消融，并将结果与历史对照队列进行比较。
前瞻性纳入30例接受CTI消融的患者作为研究队列，并与30例患者的回顾性对照队列进行比较。研究队列中的消融使用CF参数>10 g且<40 g以及800±10 g的力时间积分（FTI）进行。对照队列接受传统指导的CTI消融。在两个队列中均评估传统参数（电图和阻抗变化）。所有消融无论是否达到目标均纳入数据分析。研究队列中的所有患者以及对照队列中的27例患者均实现了双向CTI阻滞。研究队列中有3例（10%）患者（随访564±212天）复发房扑，对照队列中有3例（10%）患者（随访804±540天）复发房扑。两个队列均未出现重大并发症。传统参数与CF参数相关性较差。在研究队列中，房扑复发与FTI和消融持续时间显著降低相关，但与总平均CF无关。
使用CF参数指导消融可安全地进行CTI消融，长期结果与历史消融对照组相似。CF参数可能提供辅助信息以实现更有效的CTI消融。需要进一步研究予以证实。
