Cai Chi, Wang Jing, Niu Hong-Xia, Chu Jian-Min, Hua Wei, Zhang Shu, Yao Yan
Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 Apr 7;9:869254. doi: 10.3389/fcvm.2022.869254. eCollection 2022.
Although both high-power (HP) ablation and lesion size index (LSI) are novel approaches to make effective lesions during pulmonary vein isolation (PVI) for atrial fibrillation (AF), the optimal LSI in HP ablation for PVI is still unclear. Our study sought to explore the association between LSI and acute conduction gap formation and investigate the optimal LSI in HP ablation for PVI.
A total of 105 consecutive patients with AF who underwent HP ablation guided by LSI (LSI-guided HP) for PVI in our institute between June 2019 and July 2020 were retrospectively enrolled. Each ipsilateral PV circle was subdivided into four segments, and ablation power was set to 50 W with target LSI values at 5.0 and 4.0 for anterior and posterior walls, respectively. We compared the LSI values with and without acute conduction gaps after the initial first-pass PVI.
PVI was achieved in all patients, and the incidence of first-pass PVI was 78.1% (82/105). A total of 6,842 lesion sites were analyzed, and the acute conduction gaps were observed in 23 patients (21.9%) with 45 (0.7%) lesion points. The gap formation was significantly associated with lower LSI (3.9 ± 0.4 vs. 4.6 ± 0.4, < 0.001), lower force-time integral (82.6 ± 24.6 vs. 120.9 ± 40.4 gs, < 0.001), lower mean contact force (5.7 ± 2.4 vs. 8.5 ± 2.8 g, < 0.001), shorter ablation duration (10.5 ± 3.6 vs. 15.4 ± 6.4 s, < 0.001), lower mean temperature (34.4 ± 1.4 vs. 35.6 ± 2.6°C, < 0.001), and longer interlesion distance (4.4 ± 0.3 vs. 4.3 ± 0.4 mm, p = 0.031). As per the receiver operating characteristic analysis, the LSI had the highest predictive value for gap formation in all PVs segments, with a cutoff of 4.35 for effective ablation (sensitivity 80.0%; specificity 75.4%, areas under the curve: 0.87). The LSI of 4.55 and 3.95 had the highest predictive value for gap formation for the anterior and posterior segments of PVs, respectively.
Using LSI-guided HP ablation for PVI, more than 4.35 of LSI for all PVs segments showed the best predictive value to avoid gap formation for achieving effective first-pass PVI. The LSI of 4.55 for the anterior wall and 3.95 for the posterior wall were the best cutoff values for predicting gap formation, respectively.
虽然高功率（HP）消融和损伤大小指数（LSI）都是在心房颤动（AF）的肺静脉隔离（PVI）过程中形成有效损伤的新方法，但HP消融用于PVI的最佳LSI仍不明确。我们的研究旨在探讨LSI与急性传导间隙形成之间的关联，并研究HP消融用于PVI的最佳LSI。
回顾性纳入2019年6月至2020年7月在我院接受基于LSI指导的HP消融（LSI指导的HP）进行PVI的105例连续AF患者。将每个同侧肺静脉环分为四个节段，消融功率设定为50W，前壁和后壁的目标LSI值分别为5.0和4.0。我们比较了初次首次通过PVI后有和没有急性传导间隙的LSI值。
所有患者均成功完成PVI，首次通过PVI的发生率为78.1%（82/105）。共分析了6842个损伤部位，23例患者（21.9%）出现45个（0.7%）损伤点的急性传导间隙。间隙形成与较低的LSI（3.9±0.4对4.6±0.4，<0.001）、较低的力-时间积分（82.6±24.6对120.9±40.4gs，<0.001）、较低的平均接触力（5.7±2.4对8.5±2.8g，<0.001）、较短的消融持续时间（10.5±3.6对15.4±6.4s，<0.001）、较低的平均温度（34.4±1.4对35.6±2.6°C，<0.001）以及较长的损伤间距离（4.4±0.3对4.3±0.4mm，p=0.031）显著相关。根据受试者工作特征分析，LSI对所有肺静脉节段间隙形成的预测价值最高，有效消融的截断值为4.35（敏感性80.0%；特异性75.4%，曲线下面积：0.87）。LSI为4.55和3.95分别对肺静脉前节段和后节段间隙形成的预测价值最高。
使用LSI指导的HP消融进行PVI，所有肺静脉节段的LSI大于4.35对避免间隙形成以实现有效的首次通过PVI显示出最佳预测价值。前壁LSI为4.55和后壁LSI为3.95分别是预测间隙形成的最佳截断值。
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