Compagnucci Paolo, Valeri Yari, Conti Sergio, Volpato Giovanni, Cipolletta Laura, Parisi Quintino, D'Angelo Leonardo, Campanelli Francesca, Carboni Laura, Sgarito Giuseppe, Natale Andrea, Casella Michela, Dello Russo Antonio
Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy.
Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy.
J Interv Card Electrophysiol. 2024 Jun;67(4):855-864. doi: 10.1007/s10840-023-01705-7. Epub 2023 Dec 13.
Several novel technologies allowing catheter ablation (CA) with a favorable safety/efficacy profile have been recently developed, but not yet extensively clinically tested in the setting of ventricular tachycardia CA.
In this technical report, we overview technical aspects and preclinical/clinical information concerning the application of three novel CA technologies in the ventricular milieu: a pulsed field ablation (PFA) generator (CENTAURI™, Galaxy Medical) to be used with linear, contact force-sensing radiofrequency ablation catheters; a contact force-sensing radiofrequency ablation catheter equipped with six thermocouples and three microelectrodes (QDOT Micro™, Biosense-Webster), allowing high-resolution mapping and temperature-controlled CA; and a flexible and mesh-shaped irrigation tip, contact force-sensing radiofrequency ablation catheter (Tactiflex, Abbott). We also report three challenging VT cases in which CA was performed using these technologies.
The CENTAURI system was used with the Tacticath™ (Abbott) ablation catheter to perform ventricular PFA in a patient with advanced heart failure, electrical storm, and a deep intramural septal substrate. Microelectrode mapping using QDOT Micro™ helped to refine substrate assessment in a VT patient with congenitally corrected transposition of the great arteries, and allowed the identification of the critical components of the VT circuit, which were successfully ablated. Tactiflex™ was used in two challenging CA cases (one endocardial and one epicardial), allowing acute and mid-term control of VT episodes without adverse events.
The ideation and development of novel technologies initially intended to treat atrial arrhythmias and successfully implemented in the ventricular milieu is contributing to the progressive improvement in the clinical benefits derived from VT CA, making this procedure key for successful management of increasingly complex patients.
最近已开发出几种具有良好安全性/有效性的新型导管消融（CA）技术，但尚未在室性心动过速CA的背景下进行广泛的临床测试。
在本技术报告中，我们概述了三种新型CA技术在心室环境中的应用的技术方面以及临床前/临床信息：一种脉冲场消融（PFA）发生器（CENTAURI™，Galaxy Medical），与线性、接触力感应射频消融导管配合使用；一种配备六个热电偶和三个微电极的接触力感应射频消融导管（QDOT Micro™，Biosense-Webster），可进行高分辨率标测和温度控制的CA；以及一种灵活的网状灌注尖端、接触力感应射频消融导管（Tactiflex，雅培）。我们还报告了三例具有挑战性的室性心动过速病例，其中使用这些技术进行了CA。
CENTAURI系统与Tacticath™（雅培）消融导管配合使用，对一名患有晚期心力衰竭、电风暴和深部室间隔心肌内基质的患者进行了心室PFA。使用QDOT Micro™进行微电极标测有助于改善一名患有先天性矫正型大动脉转位的室性心动过速患者的基质评估，并有助于识别室性心动过速环路的关键组成部分，这些部分已成功消融。Tactiflex™用于两例具有挑战性的CA病例（一例心内膜病例和一例心外膜病例），可实现室性心动过速发作的急性和中期控制且无不良事件。
最初旨在治疗房性心律失常并成功应用于心室环境的新技术的构思和开发，有助于逐步提高室性心动过速CA的临床效益，使该手术成为成功管理日益复杂患者的关键。
