Visual Balloon-Guided Point-by-Point Ablation Reliable, Reproducible, and Persistent Pulmonary Vein Isolation
Visual Balloon-Guided Point-by-Point Ablation Reliable, Reproducible, and Persistent Pulmonary Vein Isolation
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DOI：
10.1161/circep.109.933283
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发表时间：
2010-06-01
影响因子：
8.4
通讯作者：
Reddy, Vivek Y.
中科院分区：
文献类型：
--
作者：
Dukkipati, Srinivas R.;Neuzil, Petr;Reddy, Vivek Y.
背景：虽然在概念上很简单，但在阵发性心房颤动患者中，放置点对点连续射频病灶以实现肺静脉隔离（PVI）在技术上具有挑战性。此外，慢性疗效受到晚期PV重新连接的限制。在最初的临床前和临床病例中测试了一种新型的柔性球囊消融导管，该导管能够提供视觉引导的短弧/点激光能量，以确定视觉引导是否可以预测可靠和持续的PVI。方法和结果：本研究包括：(1)实验猪期，包括急性（n = 15头）和4周慢性（n = 10）数据；(2)单中心临床可行性期（n = 27例阵发性心房颤动患者），以及急性和3个月慢性数据。在内镜引导下，以连续重叠的方式逐点进行围静脉消融。对每只猪PV进行纵向切片，进行详细的组织学分析。消融后3个月，无论症状如何，患者均接受预先指定的重新定位手术。在急性和慢性动物中，30只pv中有29只（97%）在放置初始周性病灶后被电隔离。对于4周的慢性动物，80%的pv保持分离；120个PV切片中有120个（100%）呈组织学周向病变，116个（96.7%）呈跨壁病变（平均跨壁性=99.0 +/- 5.5%）。在患者中，100%的pv在每个pv尝试1.3次后被分离-84%的患者（101人中有85人）在初始视觉引导病变设置后被分离。3个月时，68个pv中有61个（90%）继续电隔离。结论：使用具有逐点消融能力的视觉引导、依从性球囊消融导管，可以实现可靠、可重复和持久的PV隔离。（中国心律失常电生理杂志，2010;3:266-273）
Background-While conceptually straightforward, placing point-to-point contiguous radiofrequency lesions to achieve pulmonary vein isolation (PVI) is technically challenging in patients with paroxysmal atrial fibrillation. Furthermore, chronic efficacy is limited by late PV reconnections. A novel compliant balloon ablation catheter able to deliver visually guided short arcs/spots of laser energy was tested in initial preclinical and clinical cases to determine if visual guidance could predict reliable and persistent PVI.Methods and Results-This study consisted of (1) an experimental porcine phase with both acute (n = 15 pigs) and 4-week chronic (n = 10) data and (2) a single-center clinical feasibility phase (n = 27 patients with paroxysmal atrial fibrillation), again with acute and 3-month chronic data. Under endoscopic guidance, point-by-point perivenous ablation was performed in a contiguous and overlapping manner. Each porcine PV was longitudinally sectioned for detailed histological analysis. At 3 months after ablation, patients underwent a prespecified remapping procedure regardless of symptomotology. In the acute and chronic animals, 29 of 30 (97%) PVs were electrically isolated after placing the initial circumferential lesion set. For the 4-week chronic animals, 80% of PVs remained isolated; lesions were histologically circumferential in 120 of 120 (100%) PV sections and transmural in 116 of 120 (96.7%) PV sections (average transmurality =99.0 +/- 5.5%). In patients, 100% of the PVs were isolated after 1.3 attempts per PV-84% of them (85 of 101) isolated after the initial visually guided lesion set. At 3 months, 61 of 68 (90%) PVs continued to be electrically isolated.Conclusions-Using a visually guided, compliant balloon ablation catheter with point-by-point ablative capability, PV isolation can be achieved in a reliable, reproducible, and persistent manner. (Circ Arrhythm Electrophysiol. 2010;3:266-273.)