Completion of Mitral Isthmus Ablation Using a Steerable Sheath: Prospective Randomized Comparison With a Nonsteerable Sheath
Completion of Mitral Isthmus Ablation Using a Steerable Sheath: Prospective Randomized Comparison With a Nonsteerable Sheath
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DOI：
10.1111/j.1540-8167.2011.02112.x
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发表时间：
2011-12-01
影响因子：
2.7
通讯作者：
Yoshimura, Michihiro
中科院分区：
文献类型：
--
作者：
Matsuo, Seiichiro;Yamane, Teiichi;Yoshimura, Michihiro
完成二尖瓣峡部消融。背景：虽然心房颤动（AF）患者的二尖瓣峡部（MI）消融已被证明是一种有效的消融策略，但建立二尖瓣峡部的双向传导阻滞在技术上具有挑战性。我们研究了可操纵鞘对持续性房颤患者心肌梗死消融的有效性及其对持续性房颤消融临床结果的影响。方法：共80例连续接受心肌梗死消融的患者被随机分为以下2组中的1组：S组（使用可操纵的长鞘）或NS组（使用不可操纵的长鞘）。在三维绘图系统的引导下，使用开放冲洗消融导管进行心肌梗死消融。心肌梗死消融的终点是实现双向阻滞。结果：在14.0 +/- 6.7分钟的射频应用中，87.5%（70/80）的患者通过心肌梗死实现双向阻滞。与NS组相比，S组患者实现双向阻滞的频率更高(97.5% （39/40)vs 77.5% (31/40), P = 0.02）。此外，与NS组相比，S组需要冠状窦内心外膜消融的频率更低(12.5% （5/40)vs 72.5% (29/40), P < 0.0001）。术后房性心动过速更常发生在初始手术时未实现心肌梗塞的患者中(40.0% （4/10)vs 10.0% (7/70), P = 0.04）。结论：大多数患者可以通过使用可操纵的鞘套来实现心肌梗死阻滞。不完全心肌梗死阻断增加了持续房颤消融后发生AT的风险。（journal cardiovascular Electrophysiol, Vol. 22, pp. 1331-1338, 2011年12月）
Completion of Mitral Isthmus Ablation. Background: Although mitral isthmus (MI) ablation in atrial fibrillation (AF) patients has been shown to be an effective ablative strategy, the establishment of the bidirectional conduction block of the MI is technically challenging. We investigated the usefulness of a steerable sheath for MI ablation in patients with persistent AF and its impact on the clinical outcome of persistent AF ablation.Methods: A total of 80 consecutive patients undergoing MI ablation were randomized to 1 of the following 2 groups: group S (using a steerable long sheath) or group NS (using a nonsteerable long sheath). MI ablation was performed by using an open-irrigated ablation catheter with the guidance of a 3-dimensional mapping system. The endpoint of the MI ablation was the achievement of a bidirectional block.Results: Bidirectional block through the MI was achieved in 87.5% (70/80) of patients with 14.0 +/- 6.7 minutes of radiofrequency application. The bidirectional block was more frequently achieved in patients in group S compared to group NS (97.5% (39/40) vs 77.5% (31/40), P = 0.02). Additionally, epicardial ablation within the coronary sinus was less frequently required in group S compared to group NS (12.5% (5/40) vs 72.5% (29/40), P < 0.0001). Atrial tachycardia after the procedure more frequently occurred in the patients in whom MI block had not been achieved during the initial procedure (40.0% (4/10) vs 10.0% (7/70), P = 0.04).Conclusions: The MI block could be achieved in the majority of patients by using a steerable sheath. An incomplete MI block increased the risk of AT following persistent AF ablation. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1331-1338, December 2011)