Ding Wern Yew, Tovmassian Lilith, Bierme Cedric, Kozhuharov Nikola, Snowdon Richard L, Gupta Dhiraj
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
Indian Pacing Electrophysiol J. 2022 Jul-Aug;22(4):200-206. doi: 10.1016/j.ipej.2022.05.002. Epub 2022 May 26.
Ablation index (AI)-guided ablation for posterior wall isolation (PWI) using high-power, short-duration remains untested. We sought to evaluate the acute outcomes of AI-guided 50 W ablation vs. conventional ablation, and investigate the differences in relationship between contact force (CF), time and AI in both groups.
Consecutive patients undergoing first-time AI-guided ablation with PWI using either 50 W or 35-40 W ablation were enrolled. Acute procedural metrics and individual lesion level ablation data were compared between groups.
40 patients (50 W: n = 20, 35-40 W: n = 20) with atrial fibrillation were included. Total procedure time was significantly reduced with 50 W (120 vs. 143 mins, p = 0.004) and there was a trend toward decreased ablation time (22 vs. 28 mins, p = 0.052). First pass and acute success of PWI were comparable between the 50 W and 35-40 W groups (10 vs. 8 patients, p = 0.525 and 20 vs. 19 patients, p = 1.000, respectively). Individual lesion analysis of all 959 RF applications (50 W: n = 458, 35-40 W: n = 501) demonstrated that 50 W ablation led to lower ablation time per lesion (10.4 vs. 13.0s, p < 0.001), and increased AI (471 vs. 461, p < 0.001) and impedance drop (7.4 vs. 6.9ohms, p = 0.007). Excessive ablations (AI>600 for roof line; AI>500 elsewhere) were more frequently observed in the 50 W group (9.0% vs. 4.6%, p = 0.007). CF had very good discriminative capability for excessive ablation in both groups. At 50 W, limiting the CF to <10 g reduced the number of excessive ablations on the floor line and within the posterior box to 12% and 4%,respectively. Recurrence of atrial arrhythmias at 12 months were comparable between the groups.
AI-guided 50 W RF ablation reduces the ablation time of individual lesions and total procedure time without compromising first pass and acute success rates of PWI or 12-month outcomes compared to conventional powers.
使用高功率、短持续时间的消融指数（AI）引导下的后壁隔离（PWI）消融尚未经过测试。我们旨在评估AI引导下50W消融与传统消融的急性结果，并研究两组中接触力（CF）、时间和AI之间关系的差异。
纳入连续接受首次AI引导下PWI消融的患者，消融功率为50W或35 - 40W。比较两组之间的急性手术指标和单个病变水平的消融数据。
纳入40例房颤患者（50W组：n = 20，35 - 40W组：n = 20）。50W消融显著缩短了总手术时间（120分钟对143分钟，p = 0.004），且消融时间有缩短趋势（22分钟对28分钟，p = 0.052）。50W组和35 - 40W组的PWI首次通过成功率和急性成功率相当（分别为10例对8例患者，p = 0.525；20例对19例患者，p = 1.000）。对所有959次射频应用（50W组：n = 458，35 - 40W组：n = 501）进行单个病变分析表明，50W消融导致每个病变的消融时间更短（10.4秒对13.0秒，p < 0.001），AI增加（471对461，p < 0.001），阻抗下降（7.4欧姆对6.9欧姆，p = 0.007）。50W组更频繁观察到过度消融（房顶线AI>600；其他部位AI>500）（9.0%对4.6%，p = 0.007）。CF在两组中对过度消融均具有很好的判别能力。在50W时，将CF限制在<10g可使地板线和后箱内的过度消融数量分别降至12%和4%。两组在12个月时房性心律失常的复发率相当。
与传统功率相比，AI引导下50W射频消融可减少单个病变的消融时间和总手术时间，而不影响PWI的首次通过成功率、急性成功率或12个月的结果。
