Yano Masamichi, Egami Yasuyuki, Abe Masaru, Osuga Mizuki, Nohara Hiroaki, Kawanami Shodai, Ukita Kohei, Kawamura Akito, Yasumoto Koji, Okamoto Naotaka, Matsunaga-Lee Yasuharu, Nishino Masami
Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan.
J Cardiovasc Electrophysiol. 2025 Jan;36(1):85-94. doi: 10.1111/jce.16483. Epub 2024 Oct 30.
The impact of combining ablation index (AI)-guided and very high-power short-duration (vHPSD) ablation on procedural factors at the posterior wall near the esophagus is unclear.
Atrial fibrillation patients who underwent initial ablation using three-dimensional mapping were enrolled. Patients were classified into two groups: those who underwent only AI-guided pulmonary vein isolation (PVI) (AI group) and those who underwent vHPSD ablation at the posterior wall adjacent to the esophagus in addition to AI-guided PVI (AI + vHPSD group). Differences in myocardial injury, inflammation, procedural characteristics, and pulmonary vein (PV) reconnection patterns were assessed between the two groups.
This study included 167 patients (AI group, 83 patients; AI+vHPSD group, 84 patients). No significant differences in high-sensitive troponin I or changes in inflammatory markers between pre- and Postablation were observed in either group. Total application time and total application energy were significantly lower in the AI+vHPSD group than in the AI group (p < 0.001 for both) despite no significant difference in the total number of applications between the groups. The incidence of esophagus temperature ≥40 degrees was significantly lower in the AI+vHPSD group than in the AI group (p = 0.036). However, the incidence of PV reconnections near the esophagus was significantly higher in the AI+vHPSD group than in the AI group (11.9% vs 3.6%, p = 0.046), despite no significant difference in the incidence of PV reconnections overall.
The combination of AI-guided PVI and vHPSD adjacent to the esophagus demonstrated reduced application energy requirements and maintained safety and effectiveness during the perioperative period.
消融指数（AI）引导与超高功率短程（vHPSD）消融相结合对食管附近后壁手术因素的影响尚不清楚。
纳入接受三维标测初次消融的房颤患者。患者分为两组：仅接受AI引导下肺静脉隔离（PVI）的患者（AI组）和除AI引导下PVI外还接受食管附近后壁vHPSD消融的患者（AI + vHPSD组）。评估两组之间心肌损伤、炎症、手术特征和肺静脉（PV）重新连接模式的差异。
本研究纳入167例患者（AI组83例；AI + vHPSD组84例）。两组在高敏肌钙蛋白I或消融前后炎症标志物变化方面均未观察到显著差异。尽管两组之间总消融次数无显著差异，但AI + vHPSD组的总应用时间和总应用能量均显著低于AI组（两者p均<0.001）。AI + vHPSD组食管温度≥40度的发生率显著低于AI组（p = 0.036）。然而，尽管总体PV重新连接发生率无显著差异，但AI + vHPSD组食管附近PV重新连接的发生率显著高于AI组（11.9%对3.6%，p = 0.046）。
AI引导下PVI与食管附近vHPSD相结合在围手术期显示出降低的应用能量需求，并维持了安全性和有效性。
