Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Biosense-Webster Inc, Irvine, California, USA.
J Cardiovasc Electrophysiol. 2022 Aug;33(8):1655-1664. doi: 10.1111/jce.15550. Epub 2022 Jun 5.
To target posterior wall isolation (PWI) in atrial fibrillation (AF) ablation, diffuse ablation theoretically confers a lower risk of conduction recovery compared to box set. We sought to assess the safety and efficacy of diffuse PWI with low-flow, medium-power, and short-duration (LF-MPSD) ablation, and evaluate the durability of pulmonary vein isolation (PVI) and PWI among patients undergoing repeat ablations.
We retrospectively studied patients undergoing LF-MPSD ablation for AF (PVI + diffuse PWI) between August 2017 and December 2019. Clinical characteristics were collected. Kaplan-Meier survival analysis was performed to study AF/atrial flutter (AFL) recurrence. Ablation data were analyzed in patients who underwent a repeat AF/AFL ablation.
Of the 463 patients undergoing LF-MPSD AF ablation (PVI alone, or PVI + diffuse PWI), 137 patients had PVI + diffuse PWI. Acute PWI with complete electrocardiogram elimination was achieved in 134 (97.8%) patients. Among the 126 patients with consistent follow-up, 38 (30.2%) patients had AF/AFL recurrence during a median duration of 14 months. Eighteen patients underwent a repeat AF/AFL ablation after PVI + diffuse PWI, and 16 (88.9%) patients had durable PVI, in contrast to 10 of 45 (23.9%) patients who had redo ablation after LF-MPSD PVI alone. Seven patients (38.9%) had durable PWI, while 11 patients had partial electrical recovery at the posterior wall. The median percentage of area without electrical activity at the posterior wall was 70.7%. Conduction block across the posterior wall was maintained in 16 (88.9%) patients.
There was a high rate of PVI durability in patients undergoing diffuse PWI and PVI. Partial posterior wall electrical recovery was common but conduction block across the posterior wall was maintained in most patients.
为了实现心房颤动（AF）消融中的后间隔隔离（PWI），与框式消融相比，弥漫性消融理论上降低了传导恢复的风险。我们旨在评估低流量、中功率、短时间（LF-MPSD）消融的弥漫性 PWI 的安全性和有效性，并评估接受重复消融的患者的肺静脉隔离（PVI）和 PWI 的耐久性。
我们回顾性研究了 2017 年 8 月至 2019 年 12 月期间接受 LF-MPSD 消融治疗 AF 的患者（PVI+弥漫性 PWI）。收集临床特征。采用 Kaplan-Meier 生存分析研究 AF/房扑（AFL）复发情况。对接受重复 AF/AFL 消融的患者进行消融数据分析。
在 463 例接受 LF-MPSD AF 消融的患者中（单独 PVI 或 PVI+弥漫性 PWI），有 137 例患者行 PVI+弥漫性 PWI。134 例（97.8%）患者急性 PWI 时心电图完全消除。在 126 例具有一致性随访的患者中，38 例（30.2%）患者在中位 14 个月时出现 AF/AFL 复发。18 例患者在 PVI+弥漫性 PWI 后行重复 AF/AFL 消融，16 例（88.9%）患者行 PVI 持久，而 45 例患者中仅 10 例（23.9%）患者在 LF-MPSD PVI 后行重复消融。7 例（38.9%）患者有持久的 PWI，而 11 例患者在后壁有部分电恢复。后壁无活动面积的中位数为 70.7%。后壁的传导阻滞在 16 例（88.9%）患者中得到维持。
行弥漫性 PWI 和 PVI 的患者中 PVI 持久率较高。后壁部分电恢复很常见，但大多数患者的后壁传导阻滞仍能维持。
