Boussoussou Melinda, Szilveszter Bálint, Vattay Borbála, Kolossváry Márton, Vecsey-Nagy Milán, Salló Zoltán, Orbán Gábor, Péter Perge, Katalin Piros, Vivien Nagy Klaudia, István Osztheimer, Maurovich-Horvat Pál, Merkely Béla, Gellér László, Szegedi Nándor
Semmelweis University Heart and Vascular Center, Városmajor utca 68., Budapest, 1122, Hungary.
Medical Imaging Centre, Korányi Sándor u. 2., Budapest, 1082, Hungary.
Int J Cardiovasc Imaging. 2022 Jul;38(7):1601-1611. doi: 10.1007/s10554-022-02533-y. Epub 2022 Feb 9.
Nowadays, a novel contact-force guided ablation technique is used for enclosing pulmonary veins in patients with atrial fibrillation (AF). We sought to determine whether left atrial (LA) wall thickness (LAWT) and pulmonary vein (PV) dimensions, as assessed by cardiac CT, could influence the success rate of first-pass pulmonary vein isolation (PVI). In a single-center, prospective study, we enrolled consecutive patients with symptomatic, drug-refractory AF who underwent initial radiofrequency catheter ablation using a modified CLOSE protocol. Pre-procedural CT was performed in all cases. Additionally, the diameter and area of the PV orifices were obtained. A total of 1034 LAWT measurements and 376 PV area measurements were performed in 94 patients (mean CHADS-VASc score 2.1 ± 1.5, mean age 62.4 ± 12.6 years, 39.5% female, 38.3% persistent AF). Mean procedure time was 81.2 ± 19.3 min. Complete isolation of all PVs was achieved in 100% of patients. First-pass isolation rate was 76% and 71% for the right-sided PVs and the left-sided PVs, respectively. No difference was found regarding comorbidities and imaging parameters between those with and without first-pass isolation. LAWT (mean of 11 regions or separately) had no effect on the acute procedural outcome on logistic regression analysis (all p ≥ 0.05). Out of all assessed parameters, only RSPV diameter was associated with a higher rate of successful right-sided first pass isolation (OR 1.01, p = 0.04). Left atrial wall thickness does not have an influence on the acute procedural success of PVI using ablation index and a standardized ablation protocol. RSPV diameter could influence the probability of right sided first-pass isolation.
如今，一种新型的接触力引导消融技术被用于房颤（AF）患者的肺静脉隔离。我们试图确定通过心脏CT评估的左心房（LA）壁厚度（LAWT）和肺静脉（PV）尺寸是否会影响首次肺静脉隔离（PVI）的成功率。在一项单中心前瞻性研究中，我们纳入了连续的有症状、药物难治性AF患者，这些患者使用改良的CLOSE方案接受了初次射频导管消融。所有病例均进行了术前CT检查。此外，还获取了PV口的直径和面积。对94例患者进行了总共1034次LAWT测量和376次PV面积测量（平均CHADS-VASc评分2.1±1.5，平均年龄62.4±12.6岁，女性占39.5%，持续性AF占38.3%）。平均手术时间为81.2±19.3分钟。100%的患者实现了所有PV的完全隔离。右侧PV和左侧PV的首次隔离率分别为76%和71%。在有和没有首次隔离的患者之间，共病情况和成像参数没有差异。在逻辑回归分析中，LAWT（11个区域的平均值或分别分析）对急性手术结果没有影响（所有p≥0.05）。在所有评估参数中，只有RSPV直径与右侧首次隔离成功率较高相关（OR 1.01，p = 0.04）。使用消融指数和标准化消融方案时，左心房壁厚度对PVI的急性手术成功率没有影响。RSPV直径可能会影响右侧首次隔离的概率。
