缩短射频消融时间以优化肺静脉隔离的效率和安全性：来自 COLLABORATE 注册研究的见解。

Shortened radiofrequency delivery time to optimize efficiency and safety of pulmonary vein isolation with the radiofrequency balloon: insights from the COLLABORATE registry.

机构信息

Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.

Cardiology Department, Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium.

出版信息

Europace. 2024 Aug 30;26(9). doi: 10.1093/europace/euae227.

DOI:10.1093/europace/euae227

PMID:39228338

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11424995/

Abstract

AIMS

Previous clinical studies on pulmonary vein isolation (PVI) with a radiofrequency balloon (RFB) reported safe and effective procedures using conventional ablation settings with 20/60 s RF delivery via posterior/anterior (PST/ANT) electrodes. The latest evidence suggests that reducing the application time to 15 s (s) on the posterior wall when facing the oesophageal region is as effective as applying 20 s. To prospectively assess whether reducing RF time on PST/ANT segments to 15/45 s can ensure sufficient quality of lesion metrics and compare the new shortened ablation settings with the conventional one in terms of safety, and effectiveness at 1-year.

METHODS AND RESULTS

A total of 641 patients from seven European centres were enrolled in a collaborative registry, with 374 in the conventional RF delivery group and 267 in the shortened RF delivery group. Procedural outcomes, lesion metrics, and safety profiles were assessed and compared between the groups. Freedom of any atrial tachycarrythmias at one year was 85.4% and 88.2% in the SHRT and CONV groups, respectively. The shortened RF delivery strategy was associated with significantly shorter procedure times (median 63.5 vs. 96.5 min, P < 0.001) and shortened fluoroscopy exposure (median 10.0 vs. 14.0 min, P < 0.001) compared to conventional delivery. Efficacy metrics, including first-pass isolation rates and time to isolation, were comparable between groups. Shortened RF delivery was associated with a lower incidence of procedural complications (1.4% vs. 5.3%, P = 0.04) and optimized thermal characteristics.

CONCLUSION

Analyses from the COLLABORATE registry demonstrate that shortening RF energy delivery times to 15/45 s (PST/ANT) during PVI with the RFB resulted in comparable freedom from recurrent atrial tachyarrhythmia compared to conventional delivery times with comparable efficiency and safety.

摘要

目的

先前使用射频球囊（RFB）进行肺静脉隔离（PVI）的临床研究报告了使用常规消融设置进行安全有效的程序，通过后/前（PST/ANT）电极进行 20/60 秒 RF 输送。最新证据表明，当面对食管区域时，将后壁上的应用时间减少到 15 秒（s）与应用 20 秒一样有效。前瞻性评估在 PST/ANT 节段上将 RF 时间减少到 15/45 秒是否可以确保足够的病变指标质量，并比较新的缩短消融设置与常规设置在 1 年时的安全性和有效性。

方法和结果

来自七个欧洲中心的 641 名患者参与了一项合作登记研究，其中 374 名患者在常规 RF 输送组，267 名患者在缩短 RF 输送组。评估和比较了两组之间的程序结果、病变指标和安全性概况。一年时无任何房性心动过速的比例分别为 85.4%和 88.2%，在 SHRT 和 CONV 组中。与常规输送相比，缩短 RF 输送策略与明显更短的手术时间（中位数 63.5 与 96.5 分钟，P<0.001）和更短的透视曝光时间（中位数 10.0 与 14.0 分钟，P<0.001）相关。在两组之间，包括首次通过隔离率和隔离时间在内的疗效指标是可比的。缩短 RF 输送与较低的程序并发症发生率（1.4%与 5.3%，P=0.04）和优化的热特性相关。