Tokuda Michifumi, Yamashita Seigo, Matsuo Seiichiro, Kato Mika, Sato Hidenori, Oseto Hirotsuna, Okajima Eri, Ikewaki Hidetsugu, Isogai Ryota, Tokutake Kenichi, Yokoyama Kenichi, Narui Ryohsuke, Tanigawa Shin-Ichi, Inada Keiichi, Yoshimura Michihiro, Yamane Teiichi
Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Heart Vessels. 2018 Oct;33(10):1238-1244. doi: 10.1007/s00380-018-1159-8. Epub 2018 Apr 10.
Atrial fibrillation (AF) ablation requires transseptal puncture to access the left atrium. Recently, a radiofrequency (RF) needle was developed. The purpose of this study was to compare the incidence of MRI-confirmed acute cerebral embolism (ACE) during AF ablation procedures performed with RF needle versus mechanical needle transseptal puncture. This study consisted of 383 consecutive patients who underwent catheter ablation for AF that required transseptal puncture with mechanical or radiofrequency transseptal needles. Of those, 232 propensity score-matched patients (116 with each needle type) were included in the analysis. All patients had cerebral MRI performed 1 or 2 days after the procedure. Baseline characteristics were similar between the two groups. Total procedure time was significantly shorter in Group RF than Group non-RF (167 ± 50 vs. 181 ± 52 min, P = 0.01). ACE was detected by MRI in 59 (25%) patients. All patients with ACE were asymptomatic. Incidence of ACE was lower in Group RF than Group non-RF (19 vs. 32%, P = 0.02). B-type natriuretic peptide level was higher in the patients with ACE as compared to those without ACE (65.2 ± 68.7 vs. 44.7 ± 55.1 pg/ml, P = 0.02). In multivariable analysis, the use of RF needle and BNP level was related to the incidence of ACE (OR = 0.499, 95% CI 0.270-0.922, P = 0.03 and OR = 1.005, 95% CI 1.000-1.010, P = 0.03). Use of RF needle for transseptal puncture was associated with lower total procedure time and risk of ACE during catheter ablation of AF.
心房颤动（AF）消融术需要经房间隔穿刺进入左心房。最近，一种射频（RF）针被研发出来。本研究的目的是比较在使用RF针与机械针进行房间隔穿刺的AF消融手术过程中，MRI确诊的急性脑栓塞（ACE）的发生率。本研究纳入了383例连续接受AF导管消融术且需要使用机械或射频房间隔针进行房间隔穿刺的患者。其中，232例倾向评分匹配的患者（每种针型各116例）被纳入分析。所有患者在术后1或2天进行脑部MRI检查。两组患者的基线特征相似。RF组的总手术时间显著短于非RF组（167±50 vs. 181±52分钟，P = 0.01）。MRI检测到59例（25%）患者发生ACE。所有发生ACE的患者均无症状。RF组的ACE发生率低于非RF组（19% vs. 32%，P = 0.02）。与未发生ACE的患者相比，发生ACE的患者B型利钠肽水平更高（65.2±68.7 vs. 44.7±55.1 pg/ml，P = 0.02）。在多变量分析中，RF针的使用和BNP水平与ACE的发生率相关（OR = 0.499，95% CI 0.270 - 0.922，P = 0.03；OR = 1.005，95% CI 1.000 - 1.010，P = 0.03）。在AF导管消融术中，使用RF针进行房间隔穿刺与较短的总手术时间及较低的ACE风险相关。
