Safety of very high-power short-duration radiofrequency ablation for pulmonary vein isolation: a two-centre report with emphasis on silent oesophageal injury
Safety of very high-power short-duration radiofrequency ablation for pulmonary vein isolation: a two-centre report with emphasis on silent oesophageal injury
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DOI：
10.1093/europace/euab261
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发表时间：
2021-11-10
期刊：
影响因子：
6.1
通讯作者：
Deneke, Thomas
中科院分区：
文献类型：
--
作者：
Halbfass, Philipp;Wielandts, Jean-Yves;Deneke, Thomas
目的：通过温控消融（TCA）进行的极高功率短持续时间（vHPSD）是一种进行射频肺静脉隔离（PVI）的新模式，可以想象，其代价是食管的安全裕度较窄。在这项双中心试验中，我们旨在确定基于vHPSD的肺静脉隔离的安全性，特别强调无症状食管损伤。方法和结果90例连续房颤（AF）患者使用QDOT MICRO导管联合nGEN（Bad诺伊斯塔特，n = 45）或nMARQ发生器（布鲁日，n = 45）接受了vHPSD-PVI（90 W，3-4 s，TCA）。所有患者均接受了消融后食管内窥镜检查。记录手术参数和并发症。来自巴德诺伊斯塔特的21例患者亚组接受了脑磁共振成像（cMRI），以检测无症状脑事件（SCE）。平均年龄为67 ± 9岁，59%的患者为男性，66%的患者患有阵发性AF。所有病例均在96 ± 29分钟后进行肺静脉隔离。未报告蒸汽爆裂、心包填塞、卒中或瘘。90例患者均未出现食管溃疡（0%）。在nMARQ队列中未观察到炭化（0% vs. nGEN组11%）。21例患者中有5例（24%）的cMRI显示SCE（仅nGEN队列）。结论：温控vHPSD导管消融可直接进行肺静脉隔离，无食管溃疡或症状性并发症。使用nGEN发生器时导管头端炭化和无症状脑损伤导致进一步修改。
Aims Very high-power short-duration (vHPSD) via temperature-controlled ablation (TCA) is a new modality to perform radiofrequency pulmonary vein isolation (PVI), conceivably at the cost of a narrower safety margin towards the oesophagus. In this two-centre trial, we aimed to determine the safety of vHPSD-based PVI with specific emphasis on silent oesophageal injury. Methods and results Ninety consecutive patients with atrial fibrillation (AF) underwent vHPSD-PVI (90 W, 3-4 s, TCA) using the QDOT MICRO catheter, in conjunction with the nGEN (Bad Neustadt, n = 45) or nMARQ generator (Bruges, n = 45). All patients underwent post-ablation oesophageal endoscopy. Procedural parameters and complications were recorded. A subgroup of 21 patients from Bad Neustadt underwent cerebral magnetic resonance imaging (cMRI) to detect silent cerebral events (SCEs). Mean age was 67 +/- 9 years, 59% patients were male, and 66% patients had paroxysmal AF. Pulmonary vein isolation was obtained in all cases after 96 +/- 29 min. No steam pop, cardiac tamponade, stroke, or fistula was reported. None of the 90 patients demonstrated oesophageal ulceration (0%). Charring was not observed in the nMARQ cohort (0% vs. 11% in the nGEN group). In 5 out of 21 patients (24%), cMRI demonstrated SCE (exclusively nGEN cohort). Conclusion Temperature-controlled vHPSD catheter ablation allows straightforward PVI without evidence of oesophageal ulcerations or symptomatic complications. Catheter tip charring and silent cerebral lesions when using the nGEN generator have led to further modification.