识别肺静脉隔离过程中左心房后壁的导管蓄意运动：呼吸运动调整的有效性。
Identification of deliberate catheter motion at the left atrial posterior wall during pulmonary vein isolation: Validity of respiratory motion adjustment.
机构信息
South West Cardiothoracic Centre, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK.
Department of Medical Statistics, University of Plymouth Faculty of Health and Human Sciences, Plymouth, UK.
出版信息
J Cardiovasc Electrophysiol. 2021 Apr;32(4):994-1004. doi: 10.1111/jce.14945. Epub 2021 Feb 22.
BACKGROUND
During automated radiofrequency (RF) annotation-guided pulmonary vein isolation (PVI), respiratory motion adjustment (RMA) is recommended, yet lacks in vivo validation.
METHODS
Following contact force (CF) PVI (continuous RF, 30 W) using general anesthesia and automated RF annotation-guidance (VISITAG™: force-over-time 100% minimum 1 g; 2 mm position stability; ACCURESP™ RMA "off") in 25 patients, we retrospectively examined RMA settings "on" versus "off" at the left atrial posterior wall (LAPW).
RESULTS
Respiratory motion detection occurred in eight, permitting offline retrospective comparison of RMA settings. Significant differences in LAPW RF auto-annotation occurred according to RMA setting, with curves displaying catheter position, CF and impedance data indicating "best-fit" for catheter motion detection using RMA "off." Comparing RMA "on" versus "off," respectively: total annotated sites, 82 versus 98; median RF duration per-site, 13.3 versus 10.6 s (p < 0.0001); median force time integral 177 versus 130 gs (p = 0.0002); mean inter-tag distance (ITD), 6.0 versus 4.8 mm (p = 0.002). Considering LAPW annotated site 1-to-2 transitions resulting from deliberate catheter movement, 3 concurrent with inadvertent 0 g CF demonstrated < 0.6 s difference in RF duration. However, 13 deliberate catheter movements during constant tissue contact (ITD range: 2.1-7.0 mm) demonstrated (mean) site-1 RF duration difference 3.7 s (range: -1.3 to 11.3 s): considering multiple measures of catheter position instability, the appropriate indication of deliberate catheter motion occurred with RMA "off" in all.
CONCLUSIONS
ACCURESP™ respiratory motion adjustment importantly delayed the identification of deliberate and clinically relevant catheter motion during LAPW RF delivery, rendering auto-annotated RF display invalid. Operators seeking greater accuracy during auto-annotated RF delivery should avoid RMA use.
背景
在自动化射频（RF）标注引导肺静脉隔离（PVI）期间，建议进行呼吸运动调整（RMA），但缺乏体内验证。
方法
在全麻下使用接触力（CF）PVI（连续 RF，30 W）并进行自动 RF 标注引导（VISITAG™：力-时间 100%最小 1 g；2 mm 位置稳定性；ACCURESP™ RMA“关闭”）后，我们回顾性地检查了左心房后壁（LAPW）处 RMA“开”与“关”的设置。
结果
在 8 例患者中发生了呼吸运动检测，允许离线回顾性比较 RMA 设置。根据 RMA 设置，LAPW RF 自动标注存在显著差异，曲线显示导管位置、CF 和阻抗数据表明 RMA“关闭”时导管运动检测的“最佳拟合”。比较 RMA“开”与“关”：总标注部位分别为 82 与 98；每个部位的中位 RF 持续时间分别为 13.3 与 10.6 s（p<0.0001）；中位力时间积分分别为 177 与 130 gs（p=0.0002）；平均标签间距离（ITD）分别为 6.0 与 4.8 mm（p=0.002）。考虑到因故意导管移动导致的 LAPW 标注部位 1 到 2 的转换，有 3 次与无意的 0 g CF 同时发生的转换，RF 持续时间差异小于 0.6 s。然而，在持续组织接触时（ITD 范围：2.1-7.0 mm）发生 13 次故意导管运动，表现出（平均）部位 1 的 RF 持续时间差异为 3.7 s（范围：-1.3 到 11.3 s）：考虑到导管位置不稳定的多种测量方法，在所有情况下，RMA“关闭”都能正确指示故意导管运动。
结论
ACCURESP™呼吸运动调整重要地延迟了 LAPW RF 输送期间故意和临床相关的导管运动的识别，使得自动标注的 RF 显示无效。在自动标注 RF 输送过程中寻求更高准确性的操作人员应避免使用 RMA。
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