Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
JACC Clin Electrophysiol. 2019 Mar;5(3):354-363. doi: 10.1016/j.jacep.2019.01.017.
This study sought to determine the feasibility of a novel simplified ablation protocol targeting only the pulmonary vein antrum using the radiofrequency hot-balloon catheter in patients with paroxysmal atrial fibrillation.
Radiofrequency hot-balloon (RHB) catheter has been recently introduced into clinical practice for pulmonary vein isolation (PVI). The authors hypothesized that a novel simplified ablation protocol targeting only the PV antrum with energy application for a longer time (single-shot technique) could be an alternative approach to achieve PVI, while avoiding unnecessary energy application at the PV ostium.
A total of 61 consecutive paroxysmal atrial fibrillation patients (age 64.1 ± 10.9 years, 48 male) who underwent antrum RHB-PVI were enrolled. Energy applications were performed following the pre-specified protocol only targeting the PV antrum. If the PVI was not achieved after 2 energy applications using the RHB, a touch-up ablation was performed.
Of 241 PV, including 3 left common PV, 194 (80%) were isolated exclusively using the RHB. The target PVI average per group of 15 consecutive procedures improved from 75% (initial 15) to 89% (last 16) of patients. The injected volume was greatest in the right superior PV (13.1 ± 2.0 ml) and the smallest in the left inferior PV (10.8 ± 1.1 ml), and 23 PV (9.5%) required over 15 ml (estimated balloon diameter of 30 mm). Periprocedural complications were noted in 3 patients (4.9%), but phrenic nerve injury was not observed. Sinus rhythm maintenance at 12-month follow-up was achieved in 57 patients (93%).
A novel simplified antrum RHB-PVI appears to be a feasible technique for the treatment of paroxysmal atrial fibrillation.
本研究旨在探讨应用新型射频热球导管（RHB）针对肺静脉（PV）窦部实施简化消融方案的可行性，以期实现阵发性心房颤动（房颤）的导管消融治疗。
RHB 导管最近已被引入临床，用于实施肺静脉隔离（PVI）。我们假设，一种新的简化消融方案，仅针对 PV 窦部实施更长时间的能量消融（单次消融技术），可能是实现 PVI 的另一种替代方法，同时避免在 PV 口不必要的能量消融。
共纳入 61 例阵发性房颤患者（年龄 64.1 ± 10.9 岁，48 例男性），均接受 RHB 针对 PV 窦部的消融治疗。仅按照预设方案针对 PV 窦部实施能量消融。如果 2 次 RHB 消融后仍未达到 PVI，则进行补充消融。
241 支 PV 中，包括 3 支左总干，其中 194 支（80%）仅使用 RHB 实现了隔离。15 例连续患者的平均目标 PVI 从最初 15 例的 75%提高到最后 16 例的 89%。右肺静脉高位（13.1 ± 2.0 ml）的注射量最大，左肺静脉低位（10.8 ± 1.1 ml）的注射量最小，23 支 PV（9.5%）需要超过 15 ml（估计球囊直径 30 mm）。3 例（4.9%）患者出现围手术期并发症，但未观察到膈神经损伤。12 个月随访时 57 例（93%）患者维持窦性心律。
新型简化的 RHB 针对 PV 窦部的 PVI 似乎是一种可行的阵发性房颤治疗技术。
