Lewalter Thorsten, Weiss Christian, Mewis Christian, Jung Werner, Haverkamp Wilhelm, Proff Jochen, Bauer Wolfgang
Department of Medicine-Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Peter Osypka Heart Center Munich, Am Isarkanal 36, 81379, Munich, Germany.
Staedtisches Klinikum Lueneburg, Boegelstraße 1, 21339, Lueneburg, Germany.
J Interv Card Electrophysiol. 2017 Mar;48(2):159-166. doi: 10.1007/s10840-016-0202-x. Epub 2016 Nov 5.
Radiofrequency catheter ablation of typical atrial flutter can vary largely in duration from patient to patient. The purpose of this work was to determine optimal combination of ablation settings leading to the highest procedural efficacy.
Our retrospective multivariate analysis comprised 448 patients undergoing atrial flutter ablation with nonirrigated 8-mm catheters at 19 clinical centers. Four procedural variables were included in the prognostic model: preset maximum temperature, preset maximum power, catheter-tip material (gold vs. platinum-iridium), and ablation technique (maximum voltage-guided vs. conventional anatomical approach). Univariate and multivariate analyses were performed using the logistic regression (for acute ablation success) and Cox constant proportional hazard models (for cumulative ablation time).
Significant multivariate predictors of acute ablation success were a higher preset maximum temperature (odds 1.083 per 1 °C, P < 0.05) and gold-tip catheter (odds 2.096, P < 0.05). Predictors of cumulative ablation time were the maximum voltage-guided ablation technique (hazard ratio 1.856, P < 0.001), higher preset maximum temperature (hazard ratio 1.039 per 1 °C, P < 0.001), and gold-tip catheter (hazard ratio 1.225, P < 0.05). The combination of optimal settings (70 °C, 70 W, gold-tip catheter, maximum voltage-guided technique) increased the acute success rate from 91.7 % (for the entire study cohort) to 100 %, and reduced median cumulative ablation time from 8.3 to 4.3 min, median total procedure duration from 76 to 55 min, and median fluoroscopy time from 14 to 7 min.
The combination of maximum voltage-guided gold-tip ablation at 70 °C and 70 W was associated with 100 % ablation success and minimal ablation times for nonirrigated ablation of atrial flutter.
典型心房扑动的射频导管消融在不同患者之间的持续时间差异很大。本研究的目的是确定能带来最高手术疗效的消融设置的最佳组合。
我们的回顾性多变量分析纳入了19个临床中心使用非灌注8毫米导管进行心房扑动消融的448例患者。预后模型纳入了四个手术变量：预设最高温度、预设最大功率、导管尖端材料（金与铂铱）以及消融技术（最高电压引导与传统解剖方法）。使用逻辑回归（用于急性消融成功）和Cox恒定比例风险模型（用于累积消融时间）进行单变量和多变量分析。
急性消融成功的显著多变量预测因素为较高的预设最高温度（每1°C的比值为1.083，P < 0.05）和金尖端导管（比值为2.096，P < 0.05）。累积消融时间的预测因素为最高电压引导消融技术（风险比为1.856，P < 0.001）、较高的预设最高温度（每1°C的风险比为1.039，P < 0.001）和金尖端导管（风险比为1.225，P < 0.05）。最佳设置（70°C、70W、金尖端导管、最高电压引导技术）的组合将急性成功率从91.7%（整个研究队列）提高到100%，并将中位累积消融时间从8.3分钟减少到4.3分钟，中位总手术持续时间从76分钟减少到55分钟，中位透视时间从14分钟减少到7分钟。
70°C和70W下的最高电压引导金尖端消融组合与非灌注心房扑动消融的100%消融成功率和最短消融时间相关。
