Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
Xiamen Cardiovascular Hospital, Xiamen, China.
J Cardiovasc Electrophysiol. 2021 May;32(5):1259-1267. doi: 10.1111/jce.15011. Epub 2021 Apr 6.
Thermally induced cardiac lesions result in necrosis, edema, and inflammation. This tissue change may be seen with ultrasound. In this study, we sought to use intracardiac echocardiography (ICE) to evaluate pulmonary vein tissue morphology and assess the acute tissue changes that occur following radiofrequency (RF) or laser ablation for atrial fibrillation (AF).
Patients with AF underwent pulmonary vein isolation (PVI) using irrigated RF or laser balloon. Pre- and post-ablation ICE imaging was performed from within each pulmonary vein (PV). At least 10 transverse imaging planes per PV were evaluated and each plane was divided into eight segments. The PV/atrial wall thickness and the luminal area were measured at each segment. Twenty-seven patients underwent PVI (15 with laser, 12 with RF). Ninety-eight pulmonary veins were analyzed (58 PVs laser; 40 PVs RF). At baseline, there were no regional differences in PV wall thickness in the right-sided veins. The anterior regions of left superior pulmonary vein (LSPV) and left inferior pulmonary vein (LIPV) were significantly thicker compared with the posterior and inferior regions (p < .01). Post-ablation, PV wall thickness in RF group increased 24.1% interquartile range (IQR) (17.2%-36.7%) compared with 1.2% IQR (0.4%-8.9%) in laser group, p = .004. In all PVs, RF ablation resulted in significantly greater percent increase in wall thickness compared with laser. Additionally, RF resulted in more variable changes in regional PV wall thickness; with more increases in wall thickness in anterior versus posterior LSPV (75.4 ± 58.5% vs. 46.8 ± 55.6%, p < .01), anterior versus posterior right superior pulmonary vein (RSPV) (62.9 ± 63.9% vs. 44.6 ± 51.7%, p < .05), and superior versus inferior RSPV (69.1 ± 45.4% vs. 35.9 ± 45%, p < .05). There were no significant regional differences in PV wall thickness changes for the laser group.
Rotational ICE can be used to measure acute tissue changes with ablation. Regional variability in baseline wall thickness was nonuniformly present in PVs. Acute tissue changes occurred immediately post-ablation. Compared with laser balloon, RF shows markedly more thickening post-ablation with significant regional variations.
热诱导的心脏损伤会导致坏死、水肿和炎症。超声可观察到这种组织变化。本研究旨在使用心腔内超声心动图（ICE）评估肺静脉组织形态，并评估射频（RF）或激光消融治疗心房颤动（AF）后发生的急性组织变化。
AF 患者接受了使用灌流 RF 或激光球囊的肺静脉隔离（PVI）。在每个肺静脉（PV）内进行消融前后的 ICE 成像。对每个 PV 评估至少 10 个横切面成像平面，每个平面分为 8 个节段。测量每个节段的 PV/心房壁厚度和管腔面积。27 例患者接受了 PVI（15 例激光，12 例 RF）。共分析了 98 个肺静脉（58 个 PV 激光；40 个 PV RF）。基线时，右侧 PV 壁厚度无区域性差异。左肺上静脉（LSPV）和左肺下静脉（LIPV）的前区明显比后区和下区厚（p<.01）。与激光组相比，RF 组消融后 PV 壁厚度增加 24.1%（四分位距 [IQR]：17.2%-36.7%），差异有统计学意义（p=0.004）。在所有 PV 中，RF 消融导致的壁厚度百分比增加明显大于激光。此外，RF 导致的局部 PV 壁厚度变化更为多变；与后区相比，LSPV 前区（75.4±58.5%比 46.8±55.6%，p<.01）和右肺上静脉（RSPV）前区（62.9±63.9%比 44.6±51.7%，p<.05）的壁厚度增加更多，与下区相比，RSPV 上区（69.1±45.4%比 35.9±45%，p<.05）的壁厚度增加更多。激光组的 PV 壁厚度变化无明显区域性差异。
旋转 ICE 可用于测量消融后的急性组织变化。基线时 PV 壁厚度的区域性差异是非均匀的。消融后即刻发生急性组织变化。与激光球囊相比，RF 消融后明显更厚，且具有明显的区域性差异。
