Cardiology - Coronary Care Unit, Electrophysiology and Cardiac Pacing, Pugliese - Ciaccio Hospital, Via Pio X, 88100, Catanzaro, Italy.
S.S. di Elettrofisiologia Cardiaca, S.C. di Cardiologia, Ospedale S. Paolo, Savona, Italy.
J Interv Card Electrophysiol. 2023 Oct;66(7):1749-1757. doi: 10.1007/s10840-023-01519-7. Epub 2023 Mar 4.
A novel ablation catheter has been released to map and ablate the cavo-tricuspid isthmus (CTI) in patients with atrial flutter (AFL), improving ablation efficiency.
We evaluated the acute and long-term outcome of CTI ablation aiming at bidirectional conduction block (BDB) in a prospective, multicenter cohort study enrolling 500 patients indicated for typical AFL ablation. Patients were grouped on the basis of the AFL ablation method (linear anatomical approach, Conv group n = 425, or maximum voltage guided, MVG group, n = 75) and ablation catheter (mini-electrodes technology, MiFi group, n = 254, or a standard 8-mm ablation catheter, BLZ group, n = 246).
Complete BDB according to both validation criteria (sequential detailed activation mapping or mapping only the ablation site) was achieved in 443 patients (88.6%). The number of RF applications needed to achieve BDB was lower in the MiFi MVG group vs both the MiFi Conv group and the BLZ Conv group (3.2 ± 2 vs 5.2 ± 4 vs 9.3 ± 5, p < 0.0001 for all comparisons). Fluoroscopy time was similar among groups, whereas we observed a reduction in the procedure duration from the BLZ Conv group (61.9 ± 26min) to the MiFi MVG group (50.6 ± 17min, p = 0.048). During a mean follow-up of 548 ± 304 days, 32 (6.2%) patients suffered an AFL recurrence. No differences were found according to BDB achieved by both validation criteria.
Ablation was highly effective in achieving acute CTI BDB and long-term arrhythmia freedom irrespective of the ablation strategy or the validation criteria for CTI chosen by the operator. The use of an ablation catheter equipped with mini-electrodes technology seems to improve ablation efficiency.
Atrial Flutter Ablation in a Real World Population. (LEONARDO).
gov Identifier: NCT02591875.
一种新型消融导管已被用于在心房颤动（AFL）患者中对腔静脉-三尖瓣峡部（CTI）进行标测和消融，以提高消融效率。
我们在一项前瞻性、多中心队列研究中评估了 CTI 消融的急性和长期结果，该研究纳入了 500 例有典型 AFL 消融适应证的患者。根据 AFL 消融方法（线性解剖方法，Conv 组 n = 425 例，或最大电压指导，MVG 组，n = 75 例）和消融导管（微型电极技术，MiFi 组，n = 254 例，或标准 8-mm 消融导管，BLZ 组，n = 246 例）对患者进行分组。
443 例患者（88.6%）根据两种验证标准（顺序详细激活标测或仅标测消融部位）均达到完全双向传导阻滞（BDB）。在 MiFi MVG 组中，达到 BDB 所需的 RF 应用次数低于 MiFi Conv 组和 BLZ Conv 组（3.2 ± 2 比 5.2 ± 4 比 9.3 ± 5，所有比较均 p < 0.0001）。各组之间透视时间相似，但我们观察到从 BLZ Conv 组（61.9 ± 26min）到 MiFi MVG 组（50.6 ± 17min，p = 0.048）的手术时间缩短。在平均 548 ± 304 天的随访期间，32 例（6.2%）患者发生 AFL 复发。根据两种验证标准达到的 BDB 无差异。
无论采用哪种消融策略或操作者选择的 CTI 验证标准，消融均可有效地实现急性 CTI BDB 和长期无心律失常。使用配备微型电极技术的消融导管似乎可以提高消融效率。
在真实世界人群中进行的心房扑动消融。（LEONARDO）。
gov 标识符：NCT02591875。
