Prospective use of Ablation Index targets improves clinical outcomes following ablation for atrial fibrillation
Prospective use of Ablation Index targets improves clinical outcomes following ablation for atrial fibrillation
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DOI：
10.1111/jce.13281
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发表时间：
2017-09-01
影响因子：
2.7
通讯作者：
Gupta, Dhiraj
中科院分区：
文献类型：
--
作者：
Hussein, Ahmed;Das, Moloy;Gupta, Dhiraj
目的：射频导管消融治疗房颤后，消融组织恢复较晚导致肺静脉重新连接仍然很常见。烧蚀指数(AI)是一种新的烧蚀质量指标，它综合了接触力(Cf)、时间和功率的加权公式。我们假设，与CF引导消融相比，我们先前发表的衍生AI靶点的预期使用将导致更好的结果。方法：89例药物难治性房颤患者(49%为阵发性)接受了AI引导消融(AI组)。AI靶点前/顶550个，左房后/下段400个。将这些患者的程序和临床结果与接受CF引导消融的89名倾向匹配的对照组(CF组)进行比较。所有178个手术在其他方面都是相似的，两组都被跟踪了12个月。结果：AI组首过肺静脉隔离的发生率明显高于CF组(173[97%]vs.149[84%]个循环，P<；0.001)，急性肺静脉再通率较低(11[6%]vs.24[13%]个循环，P=0.02)。平均PVI消融时间相似(AI组：42+/-9分钟，CF组：45±14分钟，P=0.14)。AI组的中位阻抗下降显著高于CF组(13.7[9-19]Omega vs.8.8[5.2-13]Omega，P<；0.001)。CF组发生2例主要并发症，AI组无一例发生。房性快速性心律失常复发率AI组(15/89[17%])显著低于CF组(33/89[37%]，P=0.002)。结论：与CF导引消融相比，AI导引消融可显著改善房性心动过速的急性室性心动过速再通和房性快速性心律失常复发率，这可能是因为AI导引消融产生了更高质量的病变。
Aims: Late recovery of ablated tissue leading to reconnection of pulmonary veins remains common following radiofrequency catheter ablation for AF. Ablation Index (AI), a novel ablation quality marker, incorporates contact force (CF), time, and power in a weighted formula. We hypothesized that prospective use of our previously published derived AI targets would result in better outcomes when compared to CF-guided ablation.Methods: Eighty-nine consecutive drug-refractory AF patients (49% paroxysmal) underwent AI-guided ablation (AI-group). AI targets were 550 for anterior/roof and 400 for posterior/inferior left atrial segments. Procedural and clinical outcomes of these patients were compared to 89 propensity-matched controls who underwent CF-guided ablation (CF-group). All 178 procedures were otherwise similar, and both groups were followed-up for 12 months. The last 25 patients from each group underwent analysis of all VisiTags (TM) for ablation duration, CF, Force-Time Integral, and impedance drop.Results: First-pass pulmonary vein isolation (PVI) was more frequent in AI-group than in CF-group (173 [97%] vs. 149 [84%] circles, P < 0.001), and acute PV reconnection was lower (11 [6%] vs. 24 [13%] circles, P = 0.02). Mean PVI ablation time was similar (AI-group: 42 +/- 9 vs. CF-group: 45 +/- 14 minutes, P = 0.14). Median impedance drop for AI-group was significantly higher than in CF-group (13.7 [9-19] Omega vs. 8.8 [5.2-13] Omega, P < 0.001). Two major complications occurred in CF-group and none in AI-group. Atrial tachyarrhythmia recurrence was significantly lower in AI-group (15 of 89 [17%]) than in CF-group (33 of 89 [37%], P = 0.002).Conclusion: AI-guided ablation is associated with significant improvements in the incidence of acute PV reconnection and atrial tachyarrhythmia recurrence rate compared to CF-guided ablation, potentially due to creation of better quality lesions as suggested by greater impedance drop.