Clinica Montevergine, Via M. Malzoni 5, 83013, Mercogliano, Avellino, Italy.
Boston Scientific, Milan, Italy.
J Interv Card Electrophysiol. 2023 Dec;66(9):2011-2020. doi: 10.1007/s10840-023-01528-6. Epub 2023 Mar 24.
Contact force (CF)-sensing catheters have not proved superior to standard catheters in the ablation of premature ventricular contractions (PVCs) from the right and left ventricular outflow tract (RVOT, LVOT). In this context, the utility of measuring local impedance (LI) is not known. We aimed to ascertain whether the use of a catheter combining LI and CF information was associated with superior outcomes in comparison with other catheter technologies.
We compared three groups of 40 propensity-matched patients with PVCs from the OTs, ablated by means of different catheter technologies: a CF-plus LI-featured catheter, an LI-featured catheter, and a standard irrigated catheter.
The CF + LI group displayed a significantly lower risk of PVC recurrence than the standard ablation group (HR, 0.22; 95%CI, 0.07-0.71; p = 0.01). In the CF + LI group, LI drop and RF time were the only predictors of successful lesions (OR = 1.19, CI: 1.13-1.26, p < 0.001; OR = 1.06 CI: 1.01-1.07, p = 0.044, respectively). In the coronary cusps, unlike the RVOT/LVOT region, CF was not associated with LI drop (p = 0.48), and RF duration showed a linear relationship with LI drop (p < 0.001).
The use of ablation catheters that combine CF and LI information is associated with increased success in the RF ablation of PVCs from the OTs. LI drop is the most important predictor of effective lesions, but its behavior depends on the ablation site: in the coronary cusps, unlike the RVOT/LVOT region, longer RF application times are needed in order to achieve LI drops associated with successful outcomes. REGISTRY AND REGISTRATION NO.
OF THE STUDY/TRIAL: NCT03793998.
在消融右心室流出道（RVOT）和左心室流出道（LVOT）的室性早搏（PVC）方面，接触力（CF）感应导管并未优于标准导管。在这种情况下，测量局部阻抗（LI）的效用尚不清楚。我们旨在确定与其他导管技术相比，使用结合 LI 和 CF 信息的导管是否与更好的结果相关。
我们比较了三组 40 例 PVC 患者，这些患者的 PVC 来自 OT，采用不同的导管技术消融：具有 CF 和 LI 功能的导管、具有 LI 功能的导管和标准灌流导管。
与标准消融组相比，CF+LI 组 PVC 复发的风险显著降低（HR，0.22；95%CI，0.07-0.71；p=0.01）。在 CF+LI 组中，LI 下降和 RF 时间是成功病变的唯一预测因素（OR=1.19，CI：1.13-1.26，p<0.001；OR=1.06，CI：1.01-1.07，p=0.044）。在冠状动脉瓣，与 RVOT/LVOT 区域不同，CF 与 LI 下降无关（p=0.48），而 RF 持续时间与 LI 下降呈线性关系（p<0.001）。
使用结合 CF 和 LI 信息的消融导管与增加 OT 中 PVC 的 RF 消融成功率相关。LI 下降是有效病变的最重要预测因素，但它的行为取决于消融部位：在冠状动脉瓣，与 RVOT/LVOT 区域不同，需要更长的 RF 应用时间才能达到与成功结果相关的 LI 下降。
NCT03793998。
