Loss of pace capture on the ablation line: A new marker for complete radiofrequency lesions to achieve pulmonary vein isolation
Loss of pace capture on the ablation line: A new marker for complete radiofrequency lesions to achieve pulmonary vein isolation
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DOI：
10.1016/j.hrthm.2009.11.011
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发表时间：
2010-03-01
期刊：
影响因子：
5.5
通讯作者：
Michaud, Gregory F.
中科院分区：
文献类型：
--
作者：
Steven, Daniel;Reddy, Vivek Y.;Michaud, Gregory F.
背景心房颤动(房颤)的导管消融术通常涉及肺静脉(PV)的环状腔内隔离。由于不能可靠地识别消融线上的传导间隙，必须在预定的病变集合内放置更多的病变。目的探讨直接沿消融线的起搏捕获丢失与肺静脉隔离(PVI)的心电图标准的关系。方法应用三维解剖标测系统和灌注式射频消融导管，将病变放置在PV窦内，环绕同侧静脉对，直到沿消融线不再发生10 mA/2ms的起搏捕获。在消融过程中，将环形标测导管放置在同侧肺静脉，但直到失去起搏捕捉才能显示心电图。结果30例患者(57+/-12岁，男15例(50%))在2个中心(3例一期手术)行PVI，左心房内径40+/-4 mm，左心室射血分数60+/-7%。所有患者均达到完全性PVI和失去起搏捕捉的终点。当沿这条线失去起搏捕捉后显示PV电信号时，在60对静脉中有57对(95%)存在PVI。在其余的60对(5%)PV中，进一步的射频应用实现了PVI。手术时间237±46分钟，透视时间23±9分钟。对盲性PV心电图的分析显示，即使在PVI后，在60对PV中的30对(50%)的消融线上仍存在额外的起搏捕获部位；需要额外的10+/-4个射频损伤才能完全失去起搏捕获。消融后非兴奋部位的波幅降低(0.25+/-0.15 mV比0.42+/-0.32 mV，P
BACKGROUND Catheter ablation procedures for atrial fibrillation (AF) often involve circumferential antral isolation of pulmonary veins (PV). Inability to reliably identify conduction gaps on the ablation line necessitates placing additional lesions within the intended lesion set. OBJECTIVE This pilot study investigated the relationship between loss of pace capture directly along the ablation line and electrogram criteria for PV isolation (PVI).METHODS Using a 3-dimensional anatomic mapping system and irrigated-tip radiofrequency (RF) ablation catheter, lesions were placed in the PV antra to encircle ipsilateral vein pairs until pace capture at 10 mA/2 ms no longer occurred along the line. During ablation, a circular mapping catheter was placed in an ipsilateral PV, but the electrograms were not revealed until loss-of-pace capture. The procedural end point was PVI (entrance and exit block).RESULTS Thirty patients (57 +/- 12 years; 15 male [50%]) undergoing PVI in 2 centers (3 primary operators) were included (left atrial diameter 40 +/- 4 mm, left ventricular ejection fraction 60 +/- 7%). All patients reached the end points of complete PVI and loss of pace capture. When PV electrograms were revealed after loss of pace capture along the line, PVI was present in 57 of 60 (95%) vein pairs. In the remaining 3 of 60 (5%) PV pairs, further RF applications achieved PVI. The procedure duration was 237 +/- 46 minutes, with a fluoroscopy time of 23 +/- 9 minutes. Analysis of the blinded PV electrograms revealed that even after PVI was achieved, additional sites of pace capture were present on the ablation line in 30 of 60 (50%) of the PV pairs; 10 +/- 4 additional RF lesions were necessary to fully achieve loss of pace capture. After ablation, the electrogram amplitude was lower at unexcitable sites (0.25 +/- 0.15 mV vs. 0.42 +/- 0.32 mV, P