Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium.
Department of Cardiology, Universite Libre de Bruxelles (ULB), Brussels, Belgium.
J Cardiovasc Electrophysiol. 2020 May;31(5):1091-1098. doi: 10.1111/jce.14438. Epub 2020 Mar 18.
"CLOSE"-guided pulmonary vein isolation (PVI) is based on contiguous (≤6 mm) and optimized radiofrequency (RF) ablation lesions (ablation index [AI] ≥ 400 posteriorly and ≥ 550 anteriorly]. However, the optimal RF power to reach the desired AI is unknown. Therefore we evaluated the efficiency of an ablation strategy using higher power (40 W) during a first "CLOSE"-guided PVI.
Eighty consecutive patients undergoing "CLOSE"-guided PVI for symptomatic paroxysmal atrial fibrillation were ablated with 40 W (group A). Results were compared with 105 consecutive patients enrolled in the "CLOSE to CURE"-study and were ablated using the same protocol with 35 W (group B).
In group A, ablation was associated with shorter ablation procedure time (91 vs 111 minutes; P < .001), shorter fluoroscopy time (5 vs 11 minutes; P < .001), shorter PVI time (48 vs 64 minutes; P < .001), shorter RF time (20 vs 28 minutes; P < .001), lower RF time per application (22 vs 29 seconds; P < .001), less RF applications (52 vs 58; P < .001), and less catheter dislocations (1 vs 2; P = .002). The impedance drop (12 vs 13 Ω; P = .192), first-pass isolation rate (99% vs 93%; P = .141) and acute reconnection rate (6% vs 4%; P > .733) were similar in both groups (groups A and B, respectively). No complications occurred. In group A, a gastroscopy-performed in five patients with esophageal temperature rise more than 42°C-did not reveal any esophageal lesion. Postprocedural recurrence of atrial tachyarrhythmia at 1 year was not significantly different between both groups.
Using the "CLOSE"-protocol, increased power increases the efficiency of PVI without compromising patients' safety.
“CLOSE”指导下的肺静脉隔离（PVI）基于连续（≤6mm）和优化的射频（RF）消融损伤（消融指数[AI]后部≥400，前部≥550）。然而，达到所需 AI 的最佳 RF 功率尚不清楚。因此，我们评估了在首次“CLOSE”指导下的 PVI 中使用更高功率（40W）的消融策略的效率。
连续 80 例因症状性阵发性心房颤动接受“CLOSE”指导下 PVI 的患者接受 40W（A 组）消融。结果与在相同方案下接受 35W（B 组）消融的 105 例连续“CLOSE 到 CURE”研究患者进行比较。
A 组中，消融与较短的消融程序时间（91 分钟与 111 分钟；P<.001）、较短的透视时间（5 分钟与 11 分钟；P<.001）、较短的 PVI 时间（48 分钟与 64 分钟；P<.001）、较短的 RF 时间（20 分钟与 28 分钟；P<.001）、每个应用程序的 RF 时间较短（22 秒与 29 秒；P<.001）、RF 应用程序较少（52 次与 58 次；P<.001）和较少的导管脱位（1 次与 2 次；P=.002）有关。两组间（A 组和 B 组）的阻抗下降（12Ω与 13Ω；P=.192）、初次通过隔离率（99%与 93%；P=.141）和急性再连接率（6%与 4%；P>.733）相似。两组均未发生并发症。A 组中，5 例因食管温度升高超过 42°C 而行胃镜检查的患者均未发现食管损伤。两组间 1 年时房性心动过速的复发率无显著差异。
使用“CLOSE”方案，增加功率可提高 PVI 的效率，同时不影响患者的安全性。
