Saito Yuji, Nagashima Koichi, Watanabe Ryuta, Wakamatsu Yuji, Otsuka Naoto, Hirata Shu, Hirata Moyuru, Sawada Masanaru, Kurokawa Sayaka, Okumura Yasuo
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Heart Rhythm. 2025 Jul;22(7):e51-e59. doi: 10.1016/j.hrthm.2025.01.022. Epub 2025 Jan 24.
Pulsed field ablation (PFA) for paroxysmal atrial fibrillation (AF) has been gaining worldwide acceptance because of its efficacy and safety. A variable loop circular catheter (VLCC, VARIPULSE, Biosense Webster, Inc) for PFA recently launched in Japan, includes a tissue proximity indication (TPI) feature to monitor catheter-tissue contact via impedance. However, the role of TPI during pulmonary vein isolation (PVI) is unclear.
This study aims to evaluate TPI feasibility during PVI and its relationship with acute pulmonary vein (PV) reconnection.
Twenty-one patients with paroxysmal AF underwent PFA (at least 4 ablations per PV) using the VLCC. We evaluated the association between TPI-positive site percentages, voltage, left atrial wall thickness on ADAS 3D software (Adas3D Medical SL, Barcelona Spain), and acute PVI failure sites.
Four of 21 patients (8 failure sites) experienced PVI failure after primary PFA. Failure sites had significantly lower TPI-positive site percentages (0 ± 0% vs 63 ± 27%, P < .001) and higher voltage (3.57 ± 1.35 mV vs 2.06 ± 1.42 mV, P = .003) but not PV wall thickness. We found that a left atrial bipolar voltage amplitude ≥2.24 mV was determinants of PV gaps with an area under the curve of 0.83 calculating receiver operating characteristic curves. TPI-positive site percentages increased significantly (58 ± 29% to 64 ± 26%, P = .009), whereas PV gaps decreased from 3 of 28 PVs (11%) to 2 of 54 PVs (4%, P = .332) between the first 7 and last 14 cases.
Acute PVI failure was significantly associated with poor tissue contact and higher voltage. However, acute PVI failure can be prevented with improved TPI-based contact information.
阵发性心房颤动（AF）的脉冲场消融（PFA）因其有效性和安全性而在全球范围内得到认可。最近在日本推出的用于PFA的可变环圆形导管（VLCC，VARIPULSE，Biosense Webster公司）具有组织接近度指示（TPI）功能，可通过阻抗监测导管与组织的接触。然而，TPI在肺静脉隔离（PVI）中的作用尚不清楚。
本研究旨在评估PVI期间TPI的可行性及其与急性肺静脉（PV）重新连接的关系。
21例阵发性AF患者使用VLCC进行PFA（每个PV至少4次消融）。我们在ADAS 3D软件（Adas3D Medical SL，西班牙巴塞罗那）上评估了TPI阳性部位百分比、电压、左心房壁厚度与急性PVI失败部位之间的关联。
21例患者中有4例（8个失败部位）在初次PFA后出现PVI失败。失败部位的TPI阳性部位百分比显著更低（0±0%对63±27%，P<.001）且电压更高（3.57±1.35 mV对2.06±1.42 mV，P=.003），但PV壁厚度无差异。我们发现左心房双极电压幅度≥2.24 mV是PV间隙的决定因素，计算受试者操作特征曲线的曲线下面积为0.83。在前7例和后14例病例之间，TPI阳性部位百分比显著增加（58±29%至64±26%，P=.009），而PV间隙从28个PV中的3个（11%）降至54个PV中的2个（4%，P=.332）。
急性PVI失败与组织接触不良和电压较高显著相关。然而，基于TPI的接触信息得到改善后可预防急性PVI失败。
