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验证一种用于肺静脉隔离程序终点评估的多极脉冲场消融导管。

Validation of a multipolar pulsed-field ablation catheter for endpoint assessment in pulmonary vein isolation procedures.

机构信息

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.

出版信息

Europace. 2022 Sep 1;24(8):1248-1255. doi: 10.1093/europace/euac044.

Abstract

AIMS

To validate the performance of a multipolar pulsed-field ablation (PFA) catheter compared to a standard pentaspline 3D-mapping catheter for endpoint assessment of pulmonary vein isolation (PVI). PFA for PVI using single-shot devices combines the benefits of high procedural efficacy and safety. A newly available multipolar PFA catheter allows real-time recording of pulmonary vein (PV) signals during PVI.

METHODS AND RESULTS

Patients undergoing first PVI using PFA with the standard ablation protocol (eight applications per PV) were studied. Entrance and exit block (10 V/2 ms) were assessed using the PFA catheter. Subsequently, a high-density 3D electroanatomical bipolar voltage map (3D-EAM) was constructed using a standard pentaspline 3D-mapping catheter. Additional PFA applications were delivered only after confirmation of residual PV connection by 3D-EAM. In 56 patients, 213 PVs were targeted for ablation. Acute PVI was achieved in 100% of PVs: in 199/213 (93%) PVs with the standard ablation protocol alone and in the remaining 14 PVs after additional PFA applications. The accuracy of PV assessment with the PFA catheter after the standard ablation protocol was 91% (194/213 veins). In 5/213 (2.3%) PVs, the PFA catheter incorrectly indicated PV-isolation. In 14/213 (6.6%), the PFA catheter incorrectly indicated residual PV-conduction due to high-output pace-capture. Lowering the output to 5 V/1 ms reduced this observation to 0.9% (2/213) and increased the overall accuracy to 97% (206/213).

CONCLUSION

A novel multipolar PFA catheter allows reliable endpoint assessment for PVI. Due to its design, far-field sensing and high-output pace-capture can occur. Lowering the pacing output increases the accuracy from 91 to 97%.

摘要

目的

验证多极脉冲场消融(PFA)导管与标准五极 3D 标测导管在肺静脉隔离(PVI)终点评估中的性能。使用单次消融设备进行 PFA 消融治疗 PVI 结合了高手术疗效和安全性的优势。一种新的多极 PFA 导管可在 PVI 期间实时记录肺静脉(PV)信号。

方法和结果

研究了使用标准消融方案(每根 PV 进行 8 次消融)进行首次 PFA 消融的患者。使用 PFA 导管评估入口和出口阻滞(10 V/2 ms)。随后,使用标准五极 3D 标测导管构建高密度 3D 双极电压图(3D-EAM)。仅在 3D-EAM 确认残余 PV 连接后,才会额外进行 PFA 消融。在 56 例患者中,共消融 213 根 PV。100%的 PV 达到急性 PVI:213 根 PV 中的 199 根(93%)仅通过标准消融方案达到,其余 14 根在额外的 PFA 消融后达到。在标准消融方案后,PFA 导管评估 PV 的准确性为 91%(213 根静脉中的 194 根)。在 5/213(2.3%)根 PV 中,PFA 导管错误地指示 PV 隔离。在 14/213(6.6%)根 PV 中,由于高输出起搏捕获,PFA 导管错误地指示残余 PV 传导。将输出降低至 5 V/1 ms 将这种观察减少到 0.9%(213 根中的 2 根),并将总体准确性提高到 97%(206/213)。

结论

新型多极 PFA 导管可用于可靠的 PVI 终点评估。由于其设计,可能会发生远场感应和高输出起搏捕获。降低起搏输出可将准确性从 91%提高到 97%。

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