Electrophysiology Division, St. Bernards Healthcare, Jonesboro, Arkansas, USA.
Medical Affairs, Biosense Webster, Inc., Irvine, California, USA.
J Cardiovasc Electrophysiol. 2024 Sep;35(9):1817-1827. doi: 10.1111/jce.16366. Epub 2024 Jul 14.
The VARIPULSE™ variable-loop circular catheter (VLCC) is a bidirectional, multielectrode catheter that can perform electrophysiological mapping and deliver pulsed field energy through the TRUPULSE™ Generator for the treatment of atrial fibrillation. This ablation system, including the CARTO 3™ three-dimensional electroanatomical mapping system, represents a fully integrated system.
Pulsed field ablation (PFA) is a novel, primarily cardiac tissue-selective ablation technology with a minimal thermal effect, potentially eliminating the collateral tissue damage associated with radiofrequency ablation or cryoablation. Integration of a mapping system may lead to shorter fluoroscopy times and improve the usability of the system, allowing tracking of energy density and placement to confirm no areas around the vein are left untreated.
This step-by-step review covers patient selection, mapping, the step-by-step ablation workflow, details on catheter repositioning and ensuring contact, considerations for ablation of specific anatomical variations, and discussion of ablation without fluoroscopy based on our initial clinical experience.
The VLCC is part of the fully integrated PFA system designed for pulmonary vein isolation, using mapping to guide catheter placement and lesion set creation. The current workflow, which is based on our initial clinical experience, may be further refined as the PFA system is used in real-world settings.
VARIPULSE™ 可变环环形导管（VLCC）是一种双向、多电极导管，可通过 TRUPULSE™ 发生器进行电生理标测和传递脉冲场能量，用于治疗心房颤动。该消融系统包括 CARTO 3™ 三维电生理标测系统，代表了一个完全集成的系统。
脉冲场消融（PFA）是一种新颖的、主要针对心脏组织的选择性消融技术，热效应极小，可能消除与射频消融或冷冻消融相关的旁组织损伤。映射系统的集成可能会导致透视时间更短，并提高系统的可用性，允许跟踪能量密度和放置位置，以确保静脉周围没有未治疗的区域。
本分步审查涵盖了患者选择、标测、分步消融工作流程、导管重新定位和确保接触的详细信息、特定解剖变异的消融注意事项以及基于我们初步临床经验的无透视消融讨论。
VLCC 是专为肺静脉隔离而设计的完全集成的 PFA 系统的一部分，使用标测来指导导管放置和病变集的创建。当前的工作流程是基于我们的初步临床经验，随着 PFA 系统在实际环境中的应用，可能会进一步完善。
