Sun Yijun, Wang Binhao, Feng Mingjun, Yu Yibo, Gao Fang, Zhuo Weidong, Qi Yingbo, Qiu Xinhui, Chu Huimin, Fu Guohua
Arrhythmia Center, The First Affiliated Hospital of Ningbo University, Ningbo, China.
Health Science Center, Ningbo University, Ningbo, China.
Front Cardiovasc Med. 2024 Nov 26;11:1449623. doi: 10.3389/fcvm.2024.1449623. eCollection 2024.
It remains unclear whether the current recommended ablation index (AI) value is suitable for individualized catheter ablation. Prior research has established that the elimination of the negative component of the unipolar electrogram (UP-EGM) applications reflects the formation of transmural lesion during radiofrequency ablation. The aim of this study was to explore the relationship between AI values when UP-EGM turns positive during pulmonary vein isolation and recommended AI values.
A total of 50 patients with drug-refractory PAF who underwent index RFCA were consecutively included from September 2022 to January 2023. All the patients underwent AI-guided ablation. UP-EGM was also recorded during the procedure. The difference in the AI between the value when the UP-EGM turned completely positive [AI] and the recommended value at the end of ablation (AI) was compared.
A total of 2 954 lesion points were detected in 50 patients. The average values of AI at the anterior wall and the posterior wall were 420.9 and 267.4, respectively. The average AI values were 524.3 and 393.9 at the anterior wall and the posterior wall, respectively. The percentage of increase in the AI between the AI and AI groups was 22%, 28% at the anterior wall and 47%, 49% at the posterior wall ( < 0.001). After a mean follow-up duration of 11.30 ± 2.10 months, 44 patients (88%) remained in sinus rhythm without antiarrhythmic drugs.
The AI was lower than the recommended value for all the pulmonary vein regions. The recommended AI value seems to be too high for the posterior and inferior walls, but this remains to be proven in future research.
目前推荐的消融指数（AI）值是否适用于个体化导管消融仍不清楚。先前的研究表明，单极电图（UP-EGM）应用中负向成分的消除反映了射频消融过程中透壁损伤的形成。本研究的目的是探讨肺静脉隔离期间UP-EGM转为正向时的AI值与推荐的AI值之间的关系。
连续纳入2022年9月至2023年1月期间接受初次射频导管消融术（RFCA）的50例药物难治性阵发性房颤（PAF）患者。所有患者均接受AI引导下的消融。术中同时记录UP-EGM。比较UP-EGM完全转为正向时的AI值[AI]与消融结束时推荐值（AI）之间的差异。
50例患者共检测到2954个消融位点。前壁和后壁的AI平均值分别为420.9和267.4。前壁和后壁的平均AI值分别为524.3和393.9。AI组与AI组之间，前壁AI增加的百分比分别为22%、28%，后壁为47%、49%（<0.001）。平均随访11.30±2.10个月后，44例患者（88%）在未使用抗心律失常药物的情况下维持窦性心律。
所有肺静脉区域的AI均低于推荐值。对于后壁和下壁，推荐的AI值似乎过高，但这仍有待未来研究证实。
