Peichl Petr, Wichterle Dan, Schlosser Filip, Stojadinović Predrag, Nejedlo Vojtěch, Borišincová Eva, Marek Josef, Štiavnický Peter, Hašková Jana, Kautzner Josef
Department of Cardiology, IKEM, Vídeňská 1958/9, Prague 140 00, Czechia.
Cardiac Ablation Solutions, Medtronic, Minneapolis, MN, USA.
Europace. 2024 Nov 1;26(11). doi: 10.1093/europace/euae275.
Catheter ablation is an effective treatment method for recurrent ventricular tachycardias (VTs). However, at least in part, procedural and clinical outcomes are limited by challenges in generating an adequate lesion size in the ventricular myocardium. We investigated procedural and clinical outcomes of VT ablation using a novel 'large-footprint' catheter that allows the creation of larger lesions either by radiofrequency (RF) or by pulsed field (PF) energy.
In prospectively collected case series, we describe our initial experience with VT ablation using a lattice-tip, dual-energy catheter (Sphere-9, Medtronic), and a compatible proprietary electroanatomical mapping system (Affera, Medtronic). The study population consisted of 18 patients (aged 55 ± 15 years, one woman, structural heart disease: 94%, ischaemic heart disease: 56%, left ventricular ejection fraction: 34 ± 10%, electrical storm: 22%) with recurrent sustained VTs and ≥1 previously failed endocardial RF ablation with conventional irrigated-tip catheter in 66% of patients. On average, 12 ± 7 RF and 8 ± 9 PF applications were delivered per patient. In three-fourths of patients undergoing percutaneous epicardial ablation, spasms in coronary angiography were observed after PF applications. All resolved after intracoronary administration of nitrates. No acute phrenic nerve palsy was noted. One patient suffered from a stroke that resolved without sequelae. Post-ablation non-inducibility of VT was achieved in 89% of patients. Ventricular-arrhythmia-free survival at three months was 78%.
VT ablation using a dual-energy lattice-tip catheter and a novel electroanatomical mapping system is feasible. It allows rapid mapping and effective substrate modification with good outcomes during short-term follow-up.
导管消融是复发性室性心动过速（VT）的一种有效治疗方法。然而，程序和临床结果至少在一定程度上受到在心室心肌中产生足够病变大小的挑战的限制。我们研究了使用新型“大尺寸”导管进行VT消融的程序和临床结果，该导管可通过射频（RF）或脉冲场（PF）能量创建更大的病变。
在前瞻性收集的病例系列中，我们描述了使用点阵尖端双能量导管（Sphere-9，美敦力）和兼容的专有电解剖标测系统（Affera，美敦力）进行VT消融的初步经验。研究人群包括18例患者（年龄55±15岁，1名女性，结构性心脏病：94%，缺血性心脏病：56%，左心室射血分数：34±10%，电风暴：22%），患有复发性持续性VT，66%的患者先前至少有1次使用传统灌注尖端导管进行的心内膜RF消融失败。每位患者平均进行12±7次RF和8±9次PF应用。在接受经皮心外膜消融的患者中，四分之三在PF应用后观察到冠状动脉造影中的痉挛。冠状动脉内给予硝酸盐后所有痉挛均缓解。未观察到急性膈神经麻痹。1例患者发生中风，无后遗症。89%的患者消融后VT不能诱发。三个月时无室性心律失常生存率为78%。
使用双能量点阵尖端导管和新型电解剖标测系统进行VT消融是可行的。它允许快速标测和有效的基质改良，在短期随访中具有良好的结果。
