Unipolar Signal Modification as a Guide for Lesion Creation During Radiofrequency Application in the Left Atrium Prospective Study in Humans in the Setting of Paroxysmal Atrial Fibrillation Catheter Ablation
Unipolar Signal Modification as a Guide for Lesion Creation During Radiofrequency Application in the Left Atrium Prospective Study in Humans in the Setting of Paroxysmal Atrial Fibrillation Catheter Ablation
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DOI：
10.1161/circep.113.000749
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发表时间：
2013-12-01
影响因子：
8.4
通讯作者：
Rioux, Philippe
中科院分区：
文献类型：
--
作者：
Bortone, Agustin;Appetiti, Anthony;Rioux, Philippe
背景在阵发性房颤患者中，肺静脉（PV）重新连接率很高，可能与进行PV隔离（PVI）时缺乏透壁性有关。实验证明，施加射频能量时，正单极心房电描记图完成与透壁病变相关。在这方面，我们试图确定单极信号的修改是否可能是一个适当的端点逐点射频应用，并找出它是否可以改善阵发性房颤消融结果在human.Methods和结果50例（618岁，41名男性）阵发性房颤进行肺静脉隔离使用Carto和Lasso。每次射频应用持续至单极电描记图完全阳性。对照组为50例患者（63 +/-9岁，40例男性），既往按照我们机构的标准方法接受了肺静脉隔离。两组所有患者的所有肺静脉均被隔离。然而，单极组的手术和消融时间显著低于对照组，而30分钟等待时间后的肺静脉重新连接率无显著差异。总体而言，1次肺静脉隔离治疗后21 +/-4个月，不用抗心律失常药物的窦性心律维持率显著高于单极组（88%）与对照组（70%）相比（P = 0.027）结论单极信号改变是阵发性房颤患者行肺静脉隔离时射频能量输送的一个有用终点，实质性中期窦性心律维持率。
Background In patients treated for paroxysmal atrial fibrillation, the pulmonary vein (PV) reconnection rate is substantial and may be related to the lack of transmurality achievement while performing PV isolation (PVI). It has been experimentally demonstrated that positive unipolar atrial electrogram completion, when applying radiofrequency energy, was associated with transmural lesions. In this regard, we seek to determine whether the unipolar signal modification may be an appropriate end point for point-by-point radiofrequency application and find out whether it could improve the paroxysmal atrial fibrillation ablation results in humans.Methods and Results Fifty consecutive patients (618 years old, 41 men) with paroxysmal atrial fibrillation underwent PVI using Carto and Lasso. Each radiofrequency application lasted until development of a completely positive unipolar electrogram. Fifty patients (63 +/- 9 years old, 40 men), who previously underwent PVI following the standard approach of our institution, corresponded to the control group. All PVs were isolated in all patients of both groups. However, the procedural and ablation times were significantly lower in the unipolar group compared with those of the control group, whereas the PV reconnection rate, after 30 minutes of waiting time, was not significantly different. Overall, 21 +/- 4 months after 1 PVI session, the sinus rhythm maintenance rate without antiarrhythmic drugs was significantly higher (P=0.027) in the unipolar group (88%) compared with that of the control group (70%).Conclusions Unipolar signal modification is a useful end point for radiofrequency energy delivery in patients with paroxysmal atrial fibrillation who undergo PVI and leads to a substantial midterm sinus rhythm maintenance rate.