Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Heart Lung Circ. 2021 Sep;30(9):1373-1378. doi: 10.1016/j.hlc.2021.02.017. Epub 2021 Jun 11.
Reconnection of the pulmonary veins (PVs) is the most common reason for the recurrence of atrial fibrillation (AF). The ablation index is a marker of ablation lesion quality that achieves high percentages of first-pass isolation and improved AF ablation results. Most operators use a double transseptal approach with confirmation of PV isolation with a circular mapping catheter. In the present study we aimed to show that an ablation index-guided procedure using a single transseptal approach and ablation catheter only would achieve adequate PV isolation while demonstrating the critical role of the carina in PV isolation.
Sixty-six (66) consecutive patients with paroxysmal AF were included. Thirty-four (34) patients underwent wide antral circumferential ablation (WACA-only) and 32 underwent WACA+ (WACA + empiric carina isolation). All procedures were performed via single transseptal approach. Pulmonary vein isolation was confirmed with the use of a circular mapping catheter in both groups.
Compared to WACA-only, WACA+ increased the odds of PV isolation from 65% to 94% (p=0.011). In the WACA-only procedure, ablation of the carina was needed to achieve PV isolation. At the 18-month follow-up (interquartile range 15.2-20.8 months), freedom from AF was 84% for the entire cohort.
Our study confirmed the high success rate of PV isolation using the ablation index and showed that this can be achieved via a single transseptal crossing. Our study confirmed the role of the carina in PV isolation.
肺静脉（PVs）的再连接是心房颤动（AF）复发的最常见原因。消融指数是消融病变质量的标志，可实现首次通过隔离的高百分比，并改善 AF 消融结果。大多数操作者使用双房间隔穿刺术，并使用圆形标测导管确认 PV 隔离。在本研究中，我们旨在表明，使用单房间隔穿刺术和消融导管仅进行消融指数指导的程序将实现足够的 PV 隔离，同时证明嵴在 PV 隔离中的关键作用。
纳入 66 例阵发性 AF 连续患者。34 例患者接受广泛的肺静脉前庭环形消融术（仅 WACA），32 例患者接受 WACA+（WACA+经验性嵴隔离）。所有程序均通过单房间隔穿刺术进行。两组均使用圆形标测导管确认 PV 隔离。
与仅 WACA 相比，WACA+增加了从 65%到 94%的 PV 隔离可能性（p=0.011）。在仅 WACA 手术中，需要消融嵴才能实现 PV 隔离。在 18 个月的随访（四分位距 15.2-20.8 个月）中，整个队列的 AF 无复发率为 84%。
我们的研究证实了使用消融指数实现 PV 隔离的高成功率，并表明这可以通过单次房间隔穿刺术实现。我们的研究证实了嵴在 PV 隔离中的作用。
