Low complication rates using high power (45-50 W) for short duration for atrial fibrillation ablations
Low complication rates using high power (45-50 W) for short duration for atrial fibrillation ablations
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DOI：
10.1016/j.hrthm.2018.11.031
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发表时间：
2019-02-01
期刊：
影响因子：
5.5
通讯作者：
Day, John D.
中科院分区：
文献类型：
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作者：
Winkle, Roger A.;Mohanty, Sanghamitra;Day, John D.
许多中心使用25-35 W的射频（RF）能量30-60秒。有一个安全的问题，使用更高的功率，特别是在posterior wall.Objective本研究的目的是检查并发症发生率房颤（AF）消融进行高功率，短时间RF energy.METHODS我们检查了并发症发生率的4个经验丰富的中心进行AF消融在RF功率从45-50 W为2-15秒每个病变。总共对10，284名患者进行了13，974次消融。在后壁，11，436次消融使用45-50 W，持续2-10秒，2538次消融使用降低至35 W的功率，持续20秒。食管温度监测用于13，858例患者结果：年龄64 ± 11岁，男性68%，左心房大小4.46 ± 0.7cm，阵发性房颤37%，持续性房颤42%，长期性房颤20%，抗心律失常药物失效1.4 ± 0.7cm，高血压54%，糖尿病15%，既往脑血管意外/短暂性脑缺血发作7%，CHA（2）DS（2）-VASc评分2.1 +/- 1.4。手术时间为116 +/- 41分钟。并发症死亡2例（0.014%; 1例由于卒中，1例由于心房食管瘘），33例心包填塞（0.24%; 26次穿刺，7次手术），中风，48小时内6次（0.043%），中风48小时-30天，6（0.043%），肺静脉狭窄需要介入治疗2例（0.014%），膈神经麻痹2例（0.014%;均已消退），蒸汽爆裂2例（0.014%），无并发症，导管焦痂0例（0.00%）。在11，436次后壁消融中有1例发生心房食管瘘，在2538次后壁消融中有3例发生心房食管瘘（P= 0.021），尽管3例中有2例在无透视程序中没有食管监测。结论AF消融可以在45-50 W下进行，持续时间短，并发症发生率很低。高功率、短持续时间消融有可能缩短手术时间和总射频时间，并产生更局部和持久的损伤。
BACKGROUND Many centers use radiofrequency (RF) energy at 25-35 W for 30-60 seconds. There is a safety concern about using higher power, especially on the posterior wall.OBJECTIVE The purpose of this study was to examine complication rates for atrial fibrillation (AF) ablations performed with high-power, short-duration RF energy.METHODS We examined the complication rates of 4 experienced centers performing AF ablations at RF powers from 45-50 W for 2-15 seconds per lesion. In total, 13,974 ablations were performed in 10,284 patients. On the posterior wall, 11,436 ablations used 45-50 W for 2-10 seconds, and 2538 ablations used power reduced to 35 W for 20 seconds. Esophageal temperature monitoring was used in 13,858 (99.2%).RESULTS Demographics were age 64 6 11 years, male 68%, left atrial size 4.4 6 +/- 0.7 cm, paroxysmal AF 37%, persistent AF 42%, longstanding AF 20%, antiarrhythmic drugs failed 1.4 +/- 0.7, hypertension 54%, diabetes 15%, previous cerebrovascular accident/transient ischemic attack 7%, and CHA(2)DS(2)-VASc score 2.1 +/- 1.4. Procedural time was 116 +/- 41 minutes. Complications were death in 2 (0.014%; 1 due to stroke and 1 due to atrioesophageal fistula), pericardial tamponade in 33 (0.24%; 26 tapped, 7 surgical), strokes,48 hours in 6 (0.043%), strokes 48 hours-30 days in 6 (0.043%), pulmonary vein stenosis requiring intervention in 2 (0.014%), phrenic nerve paralysis in 2 (0.014%; both resolved), steam pops 2 (0.014%) without complications, and catheter char 0 (0.00%). There was 1 atrioesophageal fistula in 11,436 ablations using power 45-50 W on the posterior wall and 3 in 2538 ablated with 35 W on the posterior wall (P=.021), although 2 of the 3 had no esophageal monitoring during a fluoroless procedure.CONCLUSION AF ablations can be performed at 45-50 W for short durations with very low complication rates. High-power, short-duration ablations have the potential to shorten procedural and total RF times and create more localized and durable lesions.