前瞻性使用消融指数消融右心室流出道室性早搏：概念验证研究。

Prospective use of ablation index for the ablation of right ventricle outflow tract premature ventricular contractions: a proof of concept study.

机构信息

Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, IT, Italy.

Cardiology Department, Heart Center University Hospital Zürich, Zürich, CH, Switzerland.

出版信息

Europace. 2021 Jan 27;23(1):91-98. doi: 10.1093/europace/euaa228.

DOI:10.1093/europace/euaa228

PMID:33063099

Abstract

AIMS

Radiofrequency catheter ablation (RFCA) represents an effective option for idiopathic premature ventricular contractions (PVCs) treatment. Ablation Index (AI) is a novel ablation marker incorporating RF power, contact force, and time of delivery into a single weighted formula. Data regarding AI-guided PVCs RFCA are currently lacking. Aim of the study was to compare AI-guided and standard RFCA outcomes in patients with PVCs originating from the right ventricle outflow tract (RVOT).

METHODS AND RESULTS

Consecutive patients undergoing AI-guided RFCA of RVOT idiopathic PVCs were prospectively enrolled. Radiofrequency catheter ablation was performed following per-protocol target cut-offs of AI, depending on targeted area (RVOT free wall AI cut-off: 590; RVOT septum AI cut-off: 610). A multi-centre cohort of propensity-matched (age, sex, ejection fraction, and PVC site) patients undergoing standard PVCs RFCA was used as a comparator. Sixty AI-guided patients (44.2 ± 18.0 years old, 58% male, left ventricular ejection fraction 56.2 ± 3.8%) were enrolled; 34 (57%) were ablated in RVOT septum and 26 (43%) patients in the RVOT free wall area. Propensity match with 60 non-AI-guided patients was performed. Acute outcomes and complications resulted comparable. At 6 months, arrhythmic recurrence was more common in non-AI-guided patients whether in general (28% vs. 7% P = 0.003) or by ablated area (RVOT free wall: 27% vs. 4%, P = 0.06; RVOT septum 29% vs. 9% P = 0.05). Ablation Index guidance was associated with improved survival from arrhythmic recurrence [overall odds ratio 6.61 (1.95-22.35), P = 0.001; RVOT septum 5.99 (1.21-29.65), P = 0.028; RVOT free wall 11.86 (1.12-124.78), P = 0.039].

CONCLUSION

Ablation Index-guidance in idiopathic PVCs ablation was associated with better arrhythmic outcomes at 6 months of follow-up.

摘要

目的

射频导管消融（RFCA）是特发性室性早搏（PVCs）治疗的有效选择。消融指数（AI）是一种新的消融标记物，将射频功率、接触力和输送时间整合到一个单一的加权公式中。目前缺乏关于 AI 指导的 PVCs RFCA 的数据。本研究的目的是比较 AI 指导和标准 RFCA 在起源于右心室流出道（RVOT）的 PVCs 患者中的结果。

方法和结果

连续前瞻性纳入接受 RVOT 特发性 PVCs 的 AI 指导 RFCA 的患者。根据目标区域，遵循协议设定的 AI 目标截止值进行射频导管消融（RVOT 游离壁 AI 截止值：590；RVOT 间隔 AI 截止值：610）。使用标准 PVCs RFCA 的倾向匹配（年龄、性别、射血分数和 PVC 部位）多中心队列作为对照。纳入 60 名接受 AI 指导的患者（44.2±18.0 岁，58%为男性，左心室射血分数 56.2±3.8%）；34 例（57%）消融在 RVOT 间隔，26 例（43%）患者在 RVOT 游离壁区域。与 60 名非 AI 指导患者进行倾向匹配。急性结果和并发症相似。6 个月时，非 AI 指导患者心律失常复发更为常见（总体为 28% vs. 7%，P=0.003）或根据消融区域（RVOT 游离壁：27% vs. 4%，P=0.06；RVOT 间隔：29% vs. 9%，P=0.05）。AI 指导与心律失常复发的生存率提高相关[总体比值比 6.61（1.95-22.35），P=0.001；RVOT 间隔 5.99（1.21-29.65），P=0.028；RVOT 游离壁 11.86（1.12-124.78），P=0.039]。