使用环形电极阵列导管对心房颤动患者进行脉冲场消融：一项评估标测作用的工作流程优化研究
Pulsed field ablation using a circular electrode array catheter in patients with atrial fibrillation: A workflow optimization study evaluating the role of mapping.
作者信息
Gunawardene Melanie A, Hartmann Jens, Dickow Jannis, Wahedi Rahin, Harloff Tim, Jezuit Johanna, Tigges Eike P, Jularic Mario, Dinov Borislav, Gessler Nele, Willems Stephan
机构信息
Asklepios Hospital St. Georg, Department of Cardiology and Intensive care medicine, Hamburg, Germany.
University Hospital Giessen, Department of Cardiology, Giessen, Germany.
出版信息
Int J Cardiol Heart Vasc. 2025 Mar 31;58:101674. doi: 10.1016/j.ijcha.2025.101674. eCollection 2025 Jun.
BACKGROUND
Pulsed field ablation (PFA) with a circular-electrode-array catheter (cPFA) has shown to be effective and safe. However, data on procedural workflow are limited.
OBJECTIVE
to analyze the process of streamlining cPFA-procedures including evaluation of fluoroscopy versus 3D-map guidance and lesion characteristics.
METHODS
Consecutive AF-patients underwent cPFA-based pulmonary vein isolation (PVI) in three phases (learning-phase-I: visualization of cPFA in 3D-map; phase-II: operator blinded to 3D-map with fluoroscopy-guidance only; phase-III: optimized mapping and ablation). Additionally, hemolysis-parameters were collected.
RESULTS
A total of 35 patients (57 % paroxysmal-AF, age 63.4 ± 9.4 years) were enrolled: n = 10 phase-I, n = 15 phase-II, n = 10 in phase III. Total procedure and fluoroscopy time was 51.9 ± 9.4 and 6.7 ± 3.1 min, respectively. First-pass PFA isolation-rate was lowest in the fluoroscopy-only phase-II (I:86 %, II:81 %, III:100 %, p = 0.0079). Insufficient PV ablation with remaining conduction occurred mostly anterior (n = 8/15, 53 %) and at the carina (n = 4/15; 27 %). Following additional PFA, all 142 PVs (100 %) were acutely isolated.Procedure times between phase II and III did not differ (49 ± 8 vs. 46 ± 3 mins p = 0.23). Fluoroscopy times were longer in phase-II (phase-I: 5.8 ± 1.3, phase-II: 9.2 ± 2.9, phase-III: 3.8 ± 1.0 mins, p < 0.0001). No complications occurred. Pre- and post-ablation hemoglobin (14.4 ± 1.4 vs. 13.5 ± 1.2 g/dl, p = 0.0169) and LDH (188 ± 39 vs. 210 ± 29 U/l, p = 0.0007) were different.
CONCLUSION
The cPFA-catheter allows for fast and efficient PVI. A fluoroscopy-only approach creates distal PV ablation lesions that are associated with residual PV conduction along the carina and anterior antrum. However, with visualization and mapping, creation of wide antral ablation lesions is feasible without prolonging procedural duration.
背景
使用环形电极阵列导管进行脉冲场消融（PFA，即cPFA）已被证明是有效且安全的。然而，关于手术流程的数据有限。
目的
分析简化cPFA手术的过程，包括评估透视引导与三维地图引导以及消融灶特征。
方法
连续的房颤患者分三个阶段接受基于cPFA的肺静脉隔离（PVI）治疗（学习阶段I：在三维地图中可视化cPFA；阶段II：操作者仅在透视引导下进行操作，不看三维地图；阶段III：优化标测与消融）。此外，收集溶血参数。
结果
共纳入35例患者（57%为阵发性房颤，年龄63.4±9.4岁）：I阶段10例，II阶段15例，III阶段10例。总手术时间和透视时间分别为51.9±9.4分钟和6.7±3.1分钟。首次通过PFA实现隔离的成功率在仅透视引导的II阶段最低（I阶段：86%，II阶段：81%，III阶段：100%，p = 0.0079）。肺静脉消融不足且仍有传导的情况大多发生在前部（15例中有8例，53%）和隆突处（15例中有4例，27%）。在追加PFA后，所有142条肺静脉（100%）均被即刻隔离。II阶段和III阶段的手术时间无差异（49±8分钟与46±3分钟，p = 0.23）。II阶段的透视时间更长（I阶段：5.8±1.3分钟，II阶段：9.2±2.9分钟，III阶段：3.8±1.0分钟，p < 0.0001）。未发生并发症。消融前后血红蛋白（14.4±1.4 g/dl与13.5±1.2 g/dl，p = 0.0169）和乳酸脱氢酶（188±39 U/l与210±29 U/l，p = 0.0007）存在差异。
结论
cPFA导管可实现快速有效的肺静脉隔离。仅采用透视引导的方法会产生与沿隆突和前部窦口残留肺静脉传导相关的远端肺静脉消融灶。然而，通过可视化和标测，在不延长手术时间的情况下创建宽窦口消融灶是可行的。
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