Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Department of Cardiology, Iwata City Hospital, Iwata, Japan.
Pacing Clin Electrophysiol. 2023 Jul;46(7):607-614. doi: 10.1111/pace.14760. Epub 2023 Jun 19.
Laser balloon-based pulmonary vein isolation (LB-PVI) is available for atrial fibrillation (AF) ablation. The lesion size depends on laser energy; however, the default protocol is not an energy-based setting. We hypothesized that an energy-guided (EG) short-duration protocol may be an alternative to shorten the procedure time without affecting efficacy and safety.
We evaluated the efficacy and safety of the EG short-duration protocol (EG group) (target energy 120 J/site [12W/10s; 10W/12s; 8.5W/14s; 5.5W/22s]) compared with the default protocol (control group) (12W/20s; 10W/20s; 8.5W/20s; 5.5W/30s).
A total of 52 consecutive patients (EG: n = 27 [103veins] and control: n = 25 [91veins]) undergoing LB-PVI (64 ± 10 years, 81% male, 77% paroxysmal) were enrolled. The EG group had a shorter total time in the pulmonary vein (PV) (43.0 ± 13.9 min vs. 61.1 ± 16.0 min, p < .0001), a shorter total laser application time (1348 ± 254 sec vs. 2032 ± 424 sec, p < .0001), and lower total laser energy (12455 ± 2284J vs. 18084 ± 3746J, p < .0001). There was no difference in the total number of laser applications (p = 0269) or first-pass isolation (p = .725). Acute reconduction was identified only in one vein in the EG. No significant differences were observed in the incidence of pinhole rupture (7.4% vs. 4%, p = 1.000) or phrenic nerve palsy (3.7% vs. 12%, p = .341). During a mean follow-up of 13.5 ± 6.1 months, Kaplan-Meier analysis revealed no significant difference in atrial tachyarrhythmia recurrence (p = .227).
LB-PVI with the EG short-duration protocol may be achieved in a shorter procedure time to avoid deterioration of efficacy and safety. The EG protocol is feasible as a novel point-by-point manual laser-application approach.
基于激光球囊的肺静脉隔离术（LB-PVI）可用于治疗心房颤动（AF）。激光消融的范围取决于激光能量；然而，默认的方案并非基于能量设置。我们假设能量引导（EG）短时间方案可能是一种替代方法，可以在不影响疗效和安全性的情况下缩短手术时间。
我们评估了能量引导短时间方案（EG 组）（目标能量 120 J/部位[12W/10s；10W/12s；8.5W/14s；5.5W/22s]）与默认方案（对照组）（12W/20s；10W/20s；8.5W/20s；5.5W/30s）的疗效和安全性。
共纳入 52 例连续接受 LB-PVI 的患者（EG 组：n=27 [103 条静脉]；对照组：n=25 [91 条静脉]）。患者平均年龄为 64±10 岁，81%为男性，77%为阵发性房颤。EG 组肺静脉（PV）总时间更短（43.0±13.9 分钟 vs. 61.1±16.0 分钟，p<0.0001），激光应用总时间更短（1348±254 秒 vs. 2032±424 秒，p<0.0001），激光总能量更低（12455±2284J vs. 18084±3746J，p<0.0001）。激光应用次数（p=0.269）或初次隔离成功率（p=0.725）无差异。仅在 EG 组的一条静脉中发现急性再传导。球囊破裂（7.4% vs. 4%，p=1.000）或膈神经麻痹（3.7% vs. 12%，p=0.341）发生率无显著差异。在平均 13.5±6.1 个月的随访中，Kaplan-Meier 分析显示房性心动过速复发率无显著差异（p=0.227）。
LB-PVI 采用 EG 短时间方案可缩短手术时间，避免疗效下降。EG 方案是一种可行的新的点对点手动激光应用方法。
