Joseph Varughese Vivek, Pollock James, Richardson Chandler, Vacca Dominic, Mujadzic Hata, Siddique Sultan
Internal Medicine, Prisma Health Richland, Columbia, SC 29203, USA.
Prisma Health Cardiology, Columbia, SC 29203, USA.
Biomedicines. 2025 May 13;13(5):1186. doi: 10.3390/biomedicines13051186.
Pulsed field ablation (PFA) is a novel non-thermal modality for catheter ablation (CA) in atrial fibrillation (AF) and has been replacing traditional thermal modalities. There have been studies in the past comparing fluoroscopic (FL) versus intracardiac echocardiogram (ICE) guidance for thermal ablation modalities. However, there have not been studies that compare outcomes for PFA performed under ICE versus FL guidance. This study was designed in a longitudinal cross-sectional format. A total of 196 patients who underwent PFA for AF at Prisma Health Richland were selected for the retrospective analysis. Patients were divided into two groups: those who underwent PFA under FL guidance (103 patients) versus ICE guidance (93 patients). The recurrence of atrial arrhythmias in the six-month follow-up period was studied. Multivariate regression analysis was performed to assess the difference in the association of either modality with recurrence of atrial arrhythmias. Bayesian non-inferiority models were used to analyze the non-inferiority between the modalities. A total of 31 patients (30.1%) in the fluoro group had documented atrial arrhythmias in the six months following ablation. While 23 patients (24.7%) in the ICE group had documented atrial arrhythmias in the six-month follow-up period. The recurrence of AF was noted in 22.3% (22 patients) in the fluoro group and 14% (13 patients) in the ICE group. After running the multivariate regression analysis models, PFA under fluoroscopic guidance did not differ from ICE guidance, in terms of the recurrent atrial arrhythmias in the six-month follow-up (Adjusted Odds Ratio: 0.964; 95% CI: 0.336-2.772). The fluoro and ICE groups also did not differ in terms of six-month atrial fibrillation recurrence (Adjusted Odds Ratio: 2.43; 95% CI: 0.649-9.19). Non-inferiority analysis with Bayesian model was carried out, comparing the fluoro group and the ICE group in terms of freedom from arrhythmias in the six-month follow-up, and no inferiority was proved (95% confidence interval: -0.18-0.053), with a 61.03% chance of ICE-guided PFA being superior to fluoro guidance in terms of recurrence free interval, but statistical significance was not reached. Mean fluoroscopic time in the FL guidance group was 15.9 min, while no radiation exposure was documented in the ICE group. CA performed under FL versus ICE guidance did not differ statistically in terms of six-month recurrence of atrial arrhythmias in general and AF in particular.
脉冲场消融（PFA）是一种用于心房颤动（AF）导管消融（CA）的新型非热消融方式，并且一直在取代传统的热消融方式。过去有研究比较了荧光透视（FL）与心腔内超声心动图（ICE）对热消融方式的指导作用。然而，尚未有研究比较在ICE与FL指导下进行PFA的结果。本研究采用纵向横断面设计。总共选择了196例在Prisma Health Richland接受AF的PFA治疗的患者进行回顾性分析。患者分为两组：在FL指导下接受PFA的患者（103例）与在ICE指导下接受PFA的患者（93例）。研究了六个月随访期内心房心律失常的复发情况。进行多变量回归分析以评估两种方式与心房心律失常复发之间关联的差异。使用贝叶斯非劣效性模型分析两种方式之间的非劣效性。在氟透视组中，共有31例患者（30.1%）在消融后的六个月内记录有心房心律失常。而在ICE组中，有23例患者（24.7%）在六个月随访期内记录有心房心律失常。氟透视组中AF复发率为22.3%（22例患者），ICE组为14%（13例患者）。运行多变量回归分析模型后，在六个月随访期内，荧光透视指导下的PFA与ICE指导下的PFA在复发性心房心律失常方面没有差异（调整后的优势比：0.964；95%置信区间：0.336 - 2.772）。氟透视组和ICE组在六个月心房颤动复发方面也没有差异（调整后的优势比：2.43；95%置信区间：0.649 - 9.19）。采用贝叶斯模型进行非劣效性分析，比较氟透视组和ICE组在六个月随访期内心律失常的无发作情况，未证明氟透视组劣于ICE组（95%置信区间：-0.18 - 0.053），在无复发间期方面，ICE指导下的PFA有61.03%的可能性优于氟透视指导，但未达到统计学显著性。FL指导组的平均荧光透视时间为15.9分钟，而ICE组未记录到辐射暴露。总体而言，在FL与ICE指导下进行的CA在六个月心房心律失常复发尤其是AF复发方面在统计学上没有差异。
