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 and Peking Union Medical College, Beijing, China.
J Cardiovasc Electrophysiol. 2023 Mar;34(3):546-555. doi: 10.1111/jce.15809. Epub 2023 Feb 5.
The long-term efficacy of high-power (50 W) ablation guided by lesion size index (LSI-guided HP) for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) remains undetermined. Our study sought to assess the clinical efficacy of LSI-guided HP ablation for PVI in patients with AF and explore the potential predictors associated with clinical outcomes.
We consecutively included 186 patients with AF who underwent LSI-guided HP (50 W) ablation at Fuwai Hospital from June 2019 to October 2021. The target LSI values of 4.5-5.5 and 4.0-4.5 at the anterior and posterior walls, respectively, were used in our study. The baseline clinical characteristics, procedural and ablation data, and clinical outcomes were evaluated. The independent potential predictors associated with AF recurrence were further evaluated.
The incidence rate of first-pass PVI was 83.9% (156/186). A total of 11 883 lesions were analyzed, and compared with posterior walls of pulmonary veins, anterior walls had significantly lower mean contact force (8.2 ± 3.0 vs. 8.3 ± 2.3 g, p = .015), longer mean radiofrequency duration (16.9 ± 7.2 vs. 12.9 ± 4.5 s, p < .001) and higher mean LSI (4.8 ± 0.2 vs. 4.4 ± 0.2, p < .001). The overall incidence of periprocedural complications was 3.7%, and steam pops without pericardial effusion occurred in three patients (1.6%). During a mean follow-up of 24.0 ± 8.4 months, the overall AF recurrence-free survival was 87.1% after a single procedure. Patients with paroxysmal AF had a higher incidence of freedom from AF recurrence than those with persistent AF (91.2% vs. 80.8%, log-rank p = .034). Higher LSI (HR 0.50, p < .001) and paroxysmal AF (HR 0.39, p = .029) were significantly associated with decreased AF recurrence. By receiver operating characteristic analysis, the LSI of 4.7 and 4.3 for the anterior and posterior walls of the PVs had the highest predictive value for AF recurrence, respectively.
LSI-guided HP (50 W) ablation for PVI was an efficient and safe strategy and led to favorable single-procedure 2-year AF recurrence-free survival in patients with AF. Higher LSI and paroxysmal AF were independent predictors of decreased 2-year AF recurrence. The LSI of 4.7 for the anterior wall and 4.3 for the posterior wall of the PVs were the best cutoff values for predicting AF recurrence after LSI-guided HP ablation.
高功率（50W）消融术在病变大小指数（LSI）引导下用于心房颤动（AF）患者肺静脉隔离（PVI）的长期疗效尚未确定。我们的研究旨在评估LSI引导下高功率消融术用于AF患者PVI的临床疗效，并探索与临床结局相关的潜在预测因素。
我们连续纳入了2019年6月至2021年10月在阜外医院接受LSI引导下高功率（50W）消融术的186例AF患者。本研究中，前壁和后壁的目标LSI值分别为4.5 - 5.5和4.0 - 4.5。评估了基线临床特征、手术及消融数据和临床结局。进一步评估了与AF复发相关的独立潜在预测因素。
首次通过PVI的发生率为83.9%（156/186）。共分析了11883个消融灶，与肺静脉后壁相比，前壁的平均接触力显著更低（8.2±3.0 vs. 8.3±2.3g，p = 0.015），平均射频持续时间更长（16.9±7.2 vs. 12.9±4.5s，p < 0.001），平均LSI更高（4.8±0.2 vs. 4.4±0.2，p < 0.001）。围手术期并发症的总发生率为3.7%，3例患者（1.6%）出现无心包积液的蒸汽泡。在平均24.0±8.4个月的随访期间，单次手术后AF无复发生存率总体为87.1%。阵发性AF患者AF无复发的发生率高于持续性AF患者（91.2% vs. 80.8%，对数秩检验p = 0.034）。更高的LSI（HR 0.50，p < 0.001）和阵发性AF（HR 0.39，p = 0.029）与AF复发减少显著相关。通过受试者工作特征分析，肺静脉前壁LSI为4.7、后壁LSI为4.3时对AF复发具有最高预测价值。
LSI引导下高功率（50W）消融术用于PVI是一种有效且安全的策略，可使AF患者单次手术后获得良好的2年AF无复发生存率。更高的LSI和阵发性AF是2年AF复发减少的独立预测因素。肺静脉前壁LSI为4.7、后壁LSI为4.3是预测LSI引导下高功率消融术后AF复发的最佳截断值。
