Silicon Valley Cardiology, PAMF and Sutter Health, East Palo Alto, California.
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
Heart Rhythm. 2019 Feb;16(2):165-169. doi: 10.1016/j.hrthm.2018.11.031.
Many centers use radiofrequency (RF) energy at 25-35 W for 30-60 seconds. There is a safety concern about using higher power, especially on the posterior wall.
The purpose of this study was to examine complication rates for atrial fibrillation (AF) ablations performed with high-power, short-duration RF energy.
We examined the complication rates of 4 experienced centers performing AF ablations at RF powers from 45-50 W for 2-15 seconds per lesion. In total, 13,974 ablations were performed in 10,284 patients. On the posterior wall, 11,436 ablations used 45-50 W for 2-10 seconds, and 2538 ablations used power reduced to 35 W for 20 seconds. Esophageal temperature monitoring was used in 13,858 (99.2%).
Demographics were age 64 ± 11 years, male 68%, left atrial size 4.4 ± 0.7 cm, paroxysmal AF 37%, persistent AF 42%, longstanding AF 20%, antiarrhythmic drugs failed 1.4 ± 0.7, hypertension 54%, diabetes 15%, previous cerebrovascular accident/transient ischemic attack 7%, and CHADS-VASc score 2.1 ± 1.4. Procedural time was 116 ± 41 minutes. Complications were death in 2 (0.014%; 1 due to stroke and 1 due to atrioesophageal fistula), pericardial tamponade in 33 (0.24%; 26 tapped, 7 surgical), strokes <48 hours in 6 (0.043%), strokes 48 hours-30 days in 6 (0.043%), pulmonary vein stenosis requiring intervention in 2 (0.014%), phrenic nerve paralysis in 2 (0.014%; both resolved), steam pops 2 (0.014%) without complications, and catheter char 0 (0.00%). There was 1 atrioesophageal fistula in 11,436 ablations using power 45-50 W on the posterior wall and 3 in 2538 ablated with 35 W on the posterior wall (P = .021), although 2 of the 3 had no esophageal monitoring during a fluoroless procedure.
AF ablations can be performed at 45-50 W for short durations with very low complication rates. High-power, short-duration ablations have the potential to shorten procedural and total RF times and create more localized and durable lesions.
许多中心使用 25-35 W 的射频 (RF) 能量进行 30-60 秒的治疗。使用更高的功率存在安全隐患，尤其是在后壁。
本研究旨在探讨使用高功率、短时间 RF 能量进行心房颤动 (AF) 消融的并发症发生率。
我们检查了 4 个经验丰富的中心的并发症发生率，这些中心在 RF 功率为 45-50 W 的情况下，对每个病变进行 2-15 秒的消融。总共对 10284 例患者进行了 13974 次消融。在后壁，11436 次消融使用 45-50 W 进行 2-10 秒，2538 次消融使用功率降低至 35 W 进行 20 秒。在 13858 次（99.2%）中使用了食管温度监测。
人口统计学特征为年龄 64±11 岁，男性占 68%，左心房大小 4.4±0.7 cm，阵发性 AF 占 37%，持续性 AF 占 42%，长期 AF 占 20%，抗心律失常药物失败占 1.4±0.7，高血压占 54%，糖尿病占 15%，既往脑血管意外/短暂性脑缺血发作占 7%，CHADS-VASc 评分占 2.1±1.4。手术时间为 116±41 分钟。并发症包括 2 例死亡（0.014%；1 例因中风，1 例因食管-心房瘘），33 例心包填塞（2.4%；26 例经穿刺，7 例手术），6 例<48 小时的中风（0.043%），6 例 48 小时-30 天的中风（0.043%），2 例需要介入治疗的肺静脉狭窄（0.014%），2 例膈神经麻痹（0.014%；均已恢复），2 例蒸汽爆裂（0.014%）无并发症，导管炭化 0（0.00%）。在后壁使用 45-50 W 功率进行消融的 11436 次消融中有 1 例发生食管-心房瘘，而在后壁使用 35 W 功率进行消融的 2538 次中有 3 例（P=0.021），尽管其中 2 例在无氟过程中未进行食管监测。
AF 消融术可以在 45-50 W 的短时间内以非常低的并发症发生率进行。高功率、短时间的消融有可能缩短手术和总 RF 时间，并产生更局部和持久的病变。
