Teumer Yannick, Katov Lyuboslav, Bothner Carlo, Rottbauer Wolfgang, Weinmann-Emhardt Karolina
Ulm University Heart Center, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
J Clin Med. 2025 Jun 16;14(12):4290. doi: 10.3390/jcm14124290.
Pulsed field ablation (PFA) is a safe and effective method for pulmonary vein isolation (PVI) in atrial fibrillation (AF) patients. However, most first-generation PFA catheters are not integrated with 3D mapping systems, requiring fluoroscopy for guidance. The use of X-ray technologies, however, poses significant health risks to both patients and operating staff. Recently, a new variable-loop PFA catheter (VLC) with full 3D mapping integration allows for a novel fluoroscopy-free approach to PVI. In that regard, the aim was to evaluate and optimize a zero-fluoroscopy workflow for PVI using the VLC. Two workflows were described and compared: a conventional zero-fluoroscopy approach using a complete 3D left atrial map before ablation, and an optimized 'mapping-on-the-fly' approach that combines mapping and ablation into a continuous, real-time process for each pulmonary vein rather than performing them sequentially. Forty-one pulmonary veins were successfully treated without fluoroscopy in 10 patients (20% female, median age 61 [IQR 55.5-66.8] years). Three patients underwent the conventional workflow, while seven received the optimized workflow. The 'mapping-on-the-fly' approach significantly reduced procedural time (median 68 vs. 144 min, = 0.017) and left atrial dwell time (46 vs. 107 min, = 0.016). No fluoroscopy-related complications occurred. PVI using the fully 3D-integrated VLC can be safely and efficiently performed without fluoroscopy. The optimized 'mapping-on-the-fly' workflow improves procedural efficiency.
脉冲场消融（PFA）是心房颤动（AF）患者肺静脉隔离（PVI）的一种安全有效的方法。然而，大多数第一代PFA导管未与三维标测系统集成，需要荧光透视引导。然而，X射线技术的使用对患者和操作人员都构成了重大健康风险。最近，一种新的具有完全三维标测集成功能的可变环PFA导管（VLC）为PVI提供了一种全新的无荧光透视方法。在这方面，目的是评估和优化使用VLC进行PVI的零荧光透视工作流程。描述并比较了两种工作流程：一种是在消融前使用完整的三维左心房图的传统零荧光透视方法，另一种是优化的“实时标测”方法，该方法将标测和消融结合为每个肺静脉的连续实时过程，而不是顺序进行。10例患者（20%为女性，中位年龄61岁[四分位间距55.5 - 66.8岁]）的41条肺静脉在无荧光透视的情况下成功治疗。3例患者采用传统工作流程，7例接受优化工作流程。“实时标测”方法显著缩短了手术时间（中位时间68分钟对144分钟，P = 0.017）和左心房停留时间（46分钟对107分钟，P = 0.016）。未发生与荧光透视相关的并发症。使用完全三维集成的VLC进行PVI可以在无荧光透视的情况下安全有效地进行。优化的“实时标测”工作流程提高了手术效率。
