接触力有助于在肺静脉隔离期间实现无兴奋消融线。
Contact force facilitates the achievement of an unexcitable ablation line during pulmonary vein isolation.
机构信息
Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center, Martinistr. 52, 20246, Hamburg, Germany.
Department of Cardiology-Electrophysiology, University Hospital Cologne, Cologne, Germany.
出版信息
Clin Res Cardiol. 2018 Aug;107(8):632-641. doi: 10.1007/s00392-018-1228-0. Epub 2018 Mar 2.
AIMS
Contact force (CF) catheters provide catheter-tissue contact information to improve outcome of pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF). We evaluated different target-CF values for achievement of the additional endpoint of an unexcitable ablation line.
METHODS
A total of 106 patients undergoing PVI were randomized into three groups (G) (G1: target-CF 15 g, G2: target-CF 10 g, G3: CF concealed from operator). The PVI encircling line was divided into predefined sections. Excitable tissue along the PVI-line identified by high output pacing (10 V, 2 ms) was targeted for further ablation.
RESULTS
Mean average CF was 17.4 ± 4.7 g (G1) vs. 12.3 ± 6.0 g (G2) vs. 11.1 ± 6.5 g (G 3) (p < 0.001). Primary unexcitable ablation lines were found in 38.6, 19.4 and 5.7% (G1, G2, G3 respectively; G1 vs. G2 p < 0.05, G1 vs. G3 p < 0.001, G2 vs. G3 ns). Additional radiofrequency (RF)-energy to achieve unexcitability was lowest in G1 (3.6 ± 3.1 kJ vs. 8.6 ± 7.2 kJ (G2) and 10.4 ± 6.7 (G3), p ≤ 0.001, G2 vs. G3 ns) with accordingly lowest additional RF applications in G1 (3.0 ± 2.6 vs. 7.0 ± 5.4 in G2 and 8.4 ± 4.0 in G3; G1 vs. G2 and G3, p < 0.001, G 2 vs. G 3 ns). Sections along ablation lines with low initial CF were most likely to reveal excitability. Single procedure success was 81.9 vs. 73.5 vs. 71.4% (G 1, 2 and 3, p = 0.6) during 437 ± 254 day follow-up.
CONCLUSION
Higher tip-to-tissue CF during PVI facilitates the achievement of an unexcitable ablation line, requiring less additional RF-energy.
目的
接触力（CF）导管提供导管-组织接触信息，以改善阵发性心房颤动（PAF）中肺静脉隔离（PVI）的结果。我们评估了不同的目标-CF 值，以实现不可兴奋消融线的附加终点。
方法
共 106 例接受 PVI 的患者随机分为三组（G）（G1：目标-CF 15g，G2：目标-CF 10g，G3：CF 对操作者隐藏）。将 PVI 环绕线分为预定的部分。通过高输出起搏（10V，2ms）识别的 PVI 线上的可兴奋组织被靶向进行进一步消融。
结果
平均平均 CF 为 17.4±4.7g（G1）、12.3±6.0g（G2）、11.1±6.5g（G3）（p<0.001）。在 38.6%、19.4%和 5.7%（G1、G2、G3 分别）的患者中发现了原发性不可兴奋消融线；G1 与 G2 相比（p<0.05），G1 与 G3 相比（p<0.001），G2 与 G3 相比（p<0.001），G1 与 G3 相比（p<0.001），G1 与 G3 相比（p<0.001），G1 与 G3 相比（p<0.001）。实现不可兴奋性的额外射频（RF）能量最低的是 G1（3.6±3.1kJ 比 8.6±7.2kJ（G2）和 10.4±6.7（G3），p≤0.001，G2 与 G3 相比无统计学意义），G1 中相应的额外 RF 应用最低（3.0±2.6 比 G2 中的 7.0±5.4 和 G3 中的 8.4±4.0；G1 与 G2 和 G3 相比，p<0.001，G2 与 G3 相比无统计学意义）。消融线初始 CF 较低的部分最有可能显示兴奋性。在 437±254 天的随访期间，单程序成功率为 81.9%、73.5%和 71.4%（G1、2 和 3，p=0.6）。
结论
在 PVI 期间较高的尖端-组织 CF 有助于实现不可兴奋的消融线，需要更少的额外 RF 能量。
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