Kariki Ourania, Mililis Panagiotis, Saplaouras Athanasios, Efremidis Theodoros, Chatziantoniou Anastasios, Panagiotopoulos Ioannis, Dragasis Stylianos, Letsas Konstantinos P, Efremidis Michael
Arrhythmia Unit Onassis Cardiac Surgery Center Athens Greece.
J Arrhythm. 2024 Nov 10;40(6):1374-1378. doi: 10.1002/joa3.13180. eCollection 2024 Dec.
Pulsed field ablation (PFA) is a form of nonthermal energy that has been recently introduced for pulmonary vein isolation (PVI). A multi-electrode pentaspline catheter for delivery of PFA guided by fluoroscopy has become widely available for clinical use.
In this study, we aimed to assess whether the addition of electroanatomical mapping (EAM) for confirmation of PVI in the acute phase can increase the efficacy of the procedure in terms of arrhythmia recurrences. A total of 51 patients with atrial fibrillation (AF) scheduled for first time PVI were included in the study. Participants were assigned to receive PVI using fluoroscopy guidance only (Fluoro-only group: 31 patients) or additional validation with EAM (EAM group: 20 patients). Endpoints included arrhythmia recurrence and procedural characteristics. During a 11.2 ± 1.3 months follow-up period, arrhythmia recurrences did not statistically differ between groups (16.1% vs. 20%, .72). Procedure time was longer in the EAM group (86.5 ± 11.4 vs. 78.4 ± 9.3 min, .008). EAM revealed 5 nonisolated PVs that were re-ablated using the same catheter. Four patients of the cohort underwent a redo-procedure during the follow-up period. In all 4 cases, at least one reconnected PV was identified.
In a cohort of patients with AF undergoing first time PVI using a pentaspline PFA catheter, PVI validation with EAM did not lead to significantly different arrhythmia recurrence rates compared to PVI without EAM. In the acute phase, the rate of nonisolated PVs was low.
脉冲场消融（PFA）是一种非热能形式，最近已被用于肺静脉隔离（PVI）。一种在荧光透视引导下用于输送PFA的多电极五边形导管已广泛用于临床。
在本研究中，我们旨在评估在急性期增加电解剖标测（EAM）以确认PVI是否能在心律失常复发方面提高手术疗效。共有51例计划首次进行PVI的房颤（AF）患者纳入研究。参与者被分配接受仅使用荧光透视引导的PVI（仅荧光透视组：31例患者）或使用EAM进行额外验证（EAM组：20例患者）。终点包括心律失常复发和手术特征。在11.2±1.3个月的随访期内，两组间心律失常复发率无统计学差异（16.1%对20%，P = 0.72）。EAM组的手术时间更长（86.5±11.4对78.4±9.3分钟，P = 0.008）。EAM显示5条未隔离的肺静脉，使用同一导管再次进行了消融。该队列中有4例患者在随访期间接受了再次手术。在所有4例病例中，均发现至少一条重新连接的肺静脉。
在一组使用五边形PFA导管首次进行PVI的房颤患者中，与不使用EAM的PVI相比，使用EAM进行PVI验证并未导致心律失常复发率有显著差异。在急性期，未隔离肺静脉的发生率较低。
