Gulletta Simone, Vergara Pasquale, Gigli Lorenzo, D'Angelo Giuseppe, Radinovic Andrea, Melania Barbaro Carmela, Trevisi Nicola, Della Bella Paolo
Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Scientific Institute, Milan, Italy.
Pediatr Cardiol. 2019 Apr;40(4):713-718. doi: 10.1007/s00246-019-02051-0. Epub 2019 Jan 21.
The current approach for catheter ablation (CA) of accessory pathways (AP) includes the use of standard catheters under fluoroscopic visualization. We hypothesize that use of contact force (CF) irrigated tip catheters might increase procedural safety in pediatric patients compared to standard irrigated tip catheters, by decreasing the number of radiofrequency (RF) pulses required to obtain AP elimination. Seventy-one pediatric patients (13.7 ± 2.5 years, 45 male) with ventricular pre-excitation were enrolled in the study. CA was performed with a standard irrigated tip catheter up to June 2013 in 41 patients (Group S) and with a CF sensing irrigated tip catheter later on in 30 patients (Group CF). In the Group CF, RF was applied with a minimal CF of 5 g; CF > 35 g was avoided. Group CF procedures required less fluoroscopy (6.8 ± 4.8 min), compared to Group S (12.2 ± 10.8 min, p = 0.007). The number of RF pulses was smaller in Group CF compared to Group S (2.5 ± 2.0 vs 5.5 ± 1.9, p < 0.01). The mean CF during the effective RF pulse was 18 ± 7.7 g, force-time integral was 1040.7 ± 955.9 gs, Ablation Index was 513.0 ± 214.2. The procedure was acutely successful in 70 patients; at 12 months follow-up 2 patients had AP recurrence, one for each group. No major complications were reported. The use of CF irrigated tip catheters was associated with a smaller number of RF pulses and less fluoroscopy, as compared to mapping and ablation with standard irrigated tip catheters.
目前用于消融小儿旁路（AP）的导管消融术（CA）方法包括在荧光透视下使用标准导管。我们推测，与标准灌注尖端导管相比，使用接触力（CF）灌注尖端导管可能会减少获得AP消除所需的射频（RF）脉冲数量，从而提高小儿患者手术的安全性。71例患有心室预激的小儿患者（13.7±2.5岁，45例男性）纳入本研究。2013年6月前，41例患者（S组）使用标准灌注尖端导管进行CA，之后30例患者（CF组）使用CF感知灌注尖端导管进行CA。在CF组中，以最小5g的CF施加RF；避免CF>35g。与S组（12.2±10.8分钟，p = 0.007）相比，CF组手术所需的透视时间更少（6.8±4.8分钟）。与S组相比，CF组的RF脉冲数量更少（2.5±2.0对5.5±1.9，p<0.01）。有效RF脉冲期间的平均CF为18±7.7g，力-时间积分是1040.7±955.9gs，消融指数是513.0±214.2。70例患者手术即刻成功；在12个月随访时，2例患者AP复发，每组各1例。未报告重大并发症。与使用标准灌注尖端导管进行标测和消融相比，使用CF灌注尖端导管与较少的RF脉冲和较少的透视相关。
