区域最大耐受病变间距离对消融指数指导下房颤肺静脉隔离长期消融结局的影响

The Impact of Regional Maximum Tolerated Interlesion Distance on the Long-Term Ablation Outcomes in Ablation Index Guided Pulmonary Vein Isolation for Atrial Fibrillation.

作者信息

Kiedrowicz Radoslaw M, Wielusinski Maciej, Krasnik Wojciech, Jankowska Olga, Zakrzewski Szymon, Duda Lukasz, Peregud-Pogorzelska Małgorzata, Kladna Aleksandra, Kazmierczak Jaroslaw

机构信息

Cardiology Department, Pomeranian Medical University, Powstancow Wlkp. 72, 70-111 Szczecin, Poland.

Department of History of Medicine and Medical Ethics, Pomeranian Medical University, Rybacka 1, 70-204 Szczecin, Poland.

出版信息

J Clin Med. 2023 Aug 1;12(15):5056. doi: 10.3390/jcm12155056.

DOI:10.3390/jcm12155056

PMID:37568458

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10420066/

Abstract

BACKGROUND

An adequate interlesion distance (ILD) applied during point-by-point pulmonary vein (PV) isolation for atrial fibrillation (AF) has never been established. We hypothesized that maximum tolerated ILD may differ between PV regions and may influence long-term ablation outcomes.

METHODS

A total of 260 AF patients underwent PV isolation with 3D electroanatomical platform. Postablation, ILD values were classified into 5 groups (6-5.5 mm, 5.5-5.0 mm, 5.0-4.5 mm, 4.5-4.0 mm and <4.0 mm); the number of tags in each group was calculated and correlated with postablation AF recurrence (AFR). All measurements were performed globally for the entire encirclement around each individual PV and regionally for designated PV anatomic segments.

RESULTS

Single-procedure freedom from AF was 81% for paroxysmal and 66% for persistent AF at 12 months. Global analysis showed that AFR was not related to median ILD nor the number of lesions within each ILD tag group for any PV. Segmental analysis showed that was not related to median ILD. However, the presence of tags from the 5.5-6.0 mm ILD group located on the posterior aspect of right upper PV (RUPV) correlated with AFR. This was confirmed in a multivariable logistic regression model.

CONCLUSIONS

Maximum tolerated ILD of 6.0 mm translated into well-accepted ablation results. However, the study suggests that it may be inadequate at the posterior aspect of RUPV.

摘要

背景

在逐点肺静脉（PV）隔离治疗心房颤动（AF）过程中，合适的病变间距离（ILD）尚未确定。我们推测，最大耐受ILD在不同PV区域可能存在差异，并可能影响长期消融结果。

方法

共260例AF患者接受了基于三维电解剖平台的PV隔离术。消融后，将ILD值分为5组（6 - 5.5毫米、5.5 - 5.0毫米、5.0 - 4.5毫米、4.5 - 4.0毫米和<4.0毫米）；计算每组中的标记数量，并将其与消融后房颤复发（AFR）相关联。所有测量在每个单独PV周围的整个环周进行整体测量，并针对指定的PV解剖节段进行局部测量。

结果

阵发性AF患者单次手术无AF的比例在12个月时为81%，持续性AF患者为66%。整体分析显示，AFR与任何PV的中位ILD或每个ILD标记组内的病变数量均无关。节段分析显示，AFR与中位ILD无关。然而，位于右上PV（RUPV）后侧的5.5 - 6.0毫米ILD组的标记存在与AFR相关。这在多变量逻辑回归模型中得到证实。