Li Xinzhong, Xiao Zhiwen, Zhang Jiachen, Huang Xiaobo, Lin Hairuo, Huang Senlin, Liao Yulin, Wu Juefei, Xiu Jiancheng, Li Jianyong, Bin Jianping, Wang Yuegang
Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China.
BMC Cardiovasc Disord. 2025 Mar 7;25(1):163. doi: 10.1186/s12872-025-04597-9.
Pulmonary vein isolation (PVI) using conventional power (30-35 W) radiofrequency ablation (RFA) has been an effective treatment strategy for paroxysmal atrial fibrillation (PAF), but its longer duration may cause collateral damage to peripheral tissue including esophageal and phrenic nerve. High-power (HP) RFA, due to better transmural performance and shorter duration, may reduce the damage to adjacent tissue and is expected to be a safe and efficient ablation strategy.
In this retrospective cohort study, we included 259 patients with PAF who underwent lesion size index (LSI)-guided radiofrequency ablation. All patients underwent PVI-based ablation, and some underwent additional ablation, including superior vena cava isolation, tricuspid isthmus block, or left anterior atrial matrix modification. A total of 119 PAF patients underwent 50 W ablation. Complications and twelve-month arrhythmia-free outcomes of the procedure were compared with those of 140 patients who underwent 30-35 W ablation.
PVI was successfully achieved in all patients. The procedural duration (140.3 ± 34.4 vs. 151.3 ± 40.6 min, P = 0.022) and overall radiation (112.0 ± 67.2 vs. 188.2 ± 119.2 mGy·cm, P < 0.001) were significantly lower in the 50 W group. No major complications occurred in the high-power short-duration (HPSD) group, whereas in the conventional power group, five participants developed complications. Among them, three cases were related to venipuncture, one had pericardial tamponade, and one had slight pericardial effusion. The recurrence of arrhythmia at the twelve-month follow-up was not significantly different between the two groups [11 (9.2%) vs. 19 (13.6%), P = 0.278].
LSI-guided HPSD-RFA was demonstrated to be comparably safe and efficacious compared to conventional ablation and resulted in reduced procedure time and radiation exposure.
使用传统功率（30 - 35瓦）的射频消融术（RFA）进行肺静脉隔离（PVI）一直是阵发性心房颤动（PAF）的有效治疗策略，但其较长的持续时间可能会对包括食管和膈神经在内的周围组织造成附带损伤。高功率（HP）RFA由于具有更好的透壁性能和更短的持续时间，可能会减少对相邻组织的损伤，有望成为一种安全有效的消融策略。
在这项回顾性队列研究中，我们纳入了259例接受病变大小指数（LSI）引导下射频消融的PAF患者。所有患者均接受基于PVI的消融，部分患者还接受了额外的消融，包括上腔静脉隔离、三尖瓣峡部阻滞或左心房前部基质改良。共有119例PAF患者接受了50瓦的消融。将该手术的并发症和12个月无心律失常结局与140例接受30 - 35瓦消融的患者进行比较。
所有患者均成功实现PVI。50瓦组的手术持续时间（140.3 ± 34.4 vs. 151.3 ± 40.6分钟，P = 0.022）和总辐射量（112.0 ± 67.2 vs. 188.2 ± 119.2 mGy·cm，P < 0.001）显著更低。高功率短持续时间（HPSD）组未发生重大并发症，而在传统功率组中，有5名参与者出现并发症。其中，3例与静脉穿刺有关，1例发生心包填塞，1例有轻微心包积液。两组在12个月随访时心律失常的复发率无显著差异[11例（9.2%） vs. 19例（13.6%），P = 0.278]。
与传统消融相比，LSI引导下的HPSD - RFA被证明具有相当的安全性和有效性，并减少了手术时间和辐射暴露。
