Ablation index-guided high-power vs. moderate-power cavotricuspid isthmus ablation
Ablation index-guided high-power vs. moderate-power cavotricuspid isthmus ablation
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DOI：
10.1007/s00380-022-02125-9
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发表时间：
2022-07-19
影响因子：
1.5
通讯作者：
Takamura, Masayuki
中科院分区：
文献类型：
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作者：
Chikata, Akio;Kato, Takeshi;Takamura, Masayuki
消融指数（AI）引导消融可用于肺静脉隔离（PVI）和三尖瓣环峡部（CTI）消融。然而，射频（RF）应用功率对具有固定靶点AI的三尖瓣环峡部消融术的影响仍不清楚。在2020年7月至2021年8月期间接受AI引导下三尖瓣环峡部消融（伴或不伴肺静脉隔离）的130例药物难治性房颤和/或房扑患者被随机分配到高功率（45 W）和中等功率（35 W）组。我们在两组中使用相同的目标AI值进行CTI消融：前1/3节段为500，后2/3节段为450。共有111例患者（85.4%）出现了三尖瓣环峡部首过传导阻滞，其中7例患者（5.4%）显示三尖瓣环峡部重新连接。45 W组首过传导阻滞发生率（61/65，93.8%）显著高于35 W组（50/65，76.9%，P = 0.01）。45 W组的三尖瓣环峡部消融和三尖瓣环峡部透视时间显著短于35 W组（三尖瓣环峡部消融时间：192.3 +/- 84.8 vs. 319.8 +/- 171.4 s，P < 0.0001;三尖瓣环峡部透视时间：125.2 +/- 122.4 vs. 171.2 +/- 124.0 s，P = 0.039）。虽然没有显著差异，但在45 W组的2名患者中，在三尖瓣环峡部前段发现了蒸汽爆裂。对于采用固定AI靶点的三尖瓣环峡部消融，45 W消融策略更快，且首过传导阻滞概率高于35 W消融策略。
Ablation index (AI)-guided ablation is useful for pulmonary vein isolation (PVI) and cavotricuspid isthmus (CTI) ablation. However, the impact of radiofrequency (RF) application power on CTI ablation with a fixed target AI remains unclear. One-hundred-thirty drug-refractory atrial fibrillation and/or atrial flutter patients who underwent AI-guided CTI ablation with or without PVI between July 2020 and August 2021 were randomly assigned to high-power (45 W) and moderate-power (35 W) groups. We performed CTI ablation with the same target AI value in both groups: 500 for the anterior 1/3 segments and 450 for the posterior 2/3 segments. In total, first-pass conduction block of the CTI was obtained in 111 patients (85.4%), with 7 patients (5.4%) showing CTI reconnection. The rate of first-pass conduction block was significantly higher in the 45 W group (61/65, 93.8%) than in the 35 W group (50/65, 76.9%, P = 0.01). CTI ablation and CTI fluoroscopy time were significantly shorter in the 45 W group than in the 35 W group (CTI ablation time: 192.3 +/- 84.8 vs. 319.8 +/- 171.4 s, P < 0.0001; CTI fluoroscopy time: 125.2 +/- 122.4 vs. 171.2 +/- 124.0 s, P = 0.039). Although there was no significant difference, steam pops were identified in two patients from the 45 W group at the anterior segment of the CTI. The 45 W ablation strategy was faster and provided a higher probability of first-pass conduction block than the 35 W ablation strategy for CTI ablation with a fixed AI target.