Del Monte Alvise, Chierchia Gian Battista, Della Rocca Domenico Giovanni, Pannone Luigi, Sorgente Antonio, Bala Gezim, Monaco Cinzia, Mouram Sahar, Capulzini Cremonini Lucio, Audiat Charles, Praet Joke, Ramak Robbert, Overeinder Ingrid, Ströker Erwin, Sieira Juan, La Meir Mark, Brugada Pedro, Sarkozy Andrea, de Asmundis Carlo, Almorad Alexandre
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium.
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, 78705, USA.
J Interv Card Electrophysiol. 2024 Mar;67(2):273-283. doi: 10.1007/s10840-023-01549-1. Epub 2023 Apr 27.
Posterior wall (PW) isolation is an important adjunctive ablation target in patients with non-paroxysmal atrial fibrillation (AF). Traditionally performed with point-by-point radiofrequency (RF) ablation, PW isolation has also been performed with different cryoballoon technologies. We aimed at assessing the feasibility of PW isolation with the novel RF balloon catheter Heliostar™ (Biosense Webster, CA, USA).
We prospectively enrolled 32 consecutive patients with persistent AF scheduled for first-time ablation with the Heliostar™ device. Procedural data were compared with those from 96 consecutive persistent AF patients undergoing pulmonary vein (PV) plus PW isolation with a cryoballoon device. The ratio RF balloon/cryoballoon was 1:3 for each operator involved in the study, aiming at avoiding any imbalance related to different experience.
Single-shot PV isolation was documented in a significantly higher number of cases with the RF balloon technology compared to cryoballoon ablation (89.8% vs. 81.0%; p = 0.02, respectively). PW isolation was achieved with a similar number of balloon applications between the two groups (11 ± 4 with the RF balloon versus 11 ± 2 with the cryoballoon; p = 0.16), but in a significantly shorter time among RF balloon patients (228 ± 72 s versus 1274 ± 277 s with cryoballoon; p < 0.001). Primary safety endpoint occurred in none of the RF balloon patients versus 5 (5.2%) patients in the cryoballoon group (p = 0.33). Primary efficacy endpoint was achieved in all (100%) RF balloon patients versus 93 (96.9%) cryoballoon ones (p = 0.57). Oesophageal endoscopy did not show any signs of thermal lesions in RF balloon patients with luminal temperature rise.
RF balloon-based PW isolation was safe and promoted shorter procedure times compared to similar cryoballoon-based ablation procedures.
后壁（PW）隔离是持续性房颤（AF）患者重要的辅助消融靶点。传统上采用逐点射频（RF）消融进行PW隔离，也可使用不同的冷冻球囊技术。我们旨在评估新型RF球囊导管Heliostar™（美国加利福尼亚州Biosense Webster公司）进行PW隔离的可行性。
我们前瞻性纳入了32例计划首次使用Heliostar™设备进行消融的持续性AF患者。将手术数据与96例连续接受冷冻球囊设备进行肺静脉（PV）加PW隔离的持续性AF患者的数据进行比较。参与研究的每位操作者的RF球囊/冷冻球囊比例为1:3，旨在避免与不同经验相关的任何不平衡。
与冷冻球囊消融相比，RF球囊技术单次PV隔离的病例数显著更多（分别为89.8%对81.0%；p = 0.02）。两组间实现PW隔离的球囊应用次数相似（RF球囊为11±4次，冷冻球囊为11±2次；p = 0.16），但RF球囊组患者所需时间显著更短（228±72秒，冷冻球囊组为1274±277秒；p < 0.001）。RF球囊组患者均未发生主要安全终点事件，而冷冻球囊组有5例（5.2%）患者发生（p = 0.33）。所有（100%）RF球囊组患者达到主要疗效终点，冷冻球囊组为93例（96.9%）（p = 0.57）。食管内镜检查显示，管腔温度升高的RF球囊组患者未出现任何热损伤迹象。
与类似的基于冷冻球囊的消融手术相比，基于RF球囊的PW隔离是安全的，且手术时间更短。
