Sakamoto Yusuke, Osanai Hiroyuki, Nakashima Yoshihito, Asano Hiroshi, Ajioka Masayoshi
Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan.
Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan.
Indian Pacing Electrophysiol J. 2025 May-Jun;25(3):136-145. doi: 10.1016/j.ipej.2025.04.007. Epub 2025 Apr 24.
The optimal strategy for very high-power short-duration (vHPSD) ablation for atrial fibrillation (AF) is unclear. Data regarding the application of box isolation (BOXI) and its complications, particularly, pulmonary vein stenosis (PVS), remain scarce. We aimed to determine the optimal strategy for vHPSD in AF ablation by focusing on pulmonary vein isolation (PVI) and BOXI and assessing the acute efficacy and safety.
Patients with drug-refractory AF (n = 97) were divided into two groups: Strategy 1 (n = 50; 90 W for 4 s with PVI for the bottom line and 50 W with an ablation index [AI] of 450 for the roof line) and Strategy 2 (n = 47; based on the outcomes of Strategy 1, using AI-guided ablation). The acute efficacy and safety were compared between the groups. Pre- and post-ablation imaging was conducted to assess PVS.
Strategy 1 yielded first-pass isolation (FPI) rates of 62.5 % (PVI) and 72 % (BOXI). The weak points were the thick parts of the atrial wall and the parts with epicardial connections. Strategy 2, which was improved by AI guidance, increased the FPI rates to 97.5 % (PVI) and 95 % (BOXI) and reduced the procedural and fluoroscopy times, respectively. Follow-up imaging showed that the PVS incidence remained low and did not significantly differ between the strategies.
AI-guided ablation enhanced the efficacy of vHPSD for PVI and BOXI in Strategy 2. Furthermore, our assessment of PVS demonstrated that vHPSD maintains a favorable safety profile with a low PVS incidence.
用于房颤（AF）的超高功率短程（vHPSD）消融的最佳策略尚不清楚。关于盒状隔离（BOXI）的应用及其并发症，尤其是肺静脉狭窄（PVS）的数据仍然很少。我们旨在通过关注肺静脉隔离（PVI）和BOXI并评估急性疗效和安全性来确定房颤消融中vHPSD的最佳策略。
药物难治性房颤患者（n = 97）分为两组：策略1（n = 50；底线采用PVI，90W持续4秒，顶线采用50W，消融指数[AI]为450）和策略2（n = 47；基于策略1的结果，采用AI引导消融）。比较两组之间的急性疗效和安全性。消融前后进行成像以评估PVS。
策略1的首次通过隔离（FPI）率分别为62.5%（PVI）和72%（BOXI）。薄弱点是心房壁的增厚部分和有心外膜连接的部分。通过AI引导改进的策略2将FPI率分别提高到97.5%（PVI）和95%（BOXI），并分别减少了手术时间和透视时间。随访成像显示，PVS发生率仍然较低，且两种策略之间无显著差异。
AI引导消融提高了策略2中vHPSD对PVI和BOXI的疗效。此外，我们对PVS的评估表明，vHPSD具有良好的安全性，PVS发生率较低。
