Pulmonary vein encirclement using an Ablation Index-guided point-by-point workflow: cardiovascular magnetic resonance assessment of left atrial scar formation
Pulmonary vein encirclement using an Ablation Index-guided point-by-point workflow: cardiovascular magnetic resonance assessment of left atrial scar formation
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DOI：
10.1093/europace/euz226
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发表时间：
2019-12-01
期刊：
影响因子：
6.1
通讯作者：
Williams, Steven E.
中科院分区：
文献类型：
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作者：
O'Neill, Louisa;Karim, Rashed;Williams, Steven E.
目的针对预定义的消融指数值(接触力、时间和功率的组合)和最小化病变间距离的逐点肺静脉隔离(PVI)工作流程可能会优化连续消融病变的创建，同时最大限度地减少疤痕形成。我们的目的是比较使用这种工作流程的PVI患者和使用持续导管拖拽工作流程的患者的消融瘢痕形成情况。方法和结果采用参数引导的逐点工作流程对26例首次PVI患者进行消融后心血管磁共振成像。通过分析左房晚期Gd增强序列，确定左房总瘢痕负荷和肺静脉环的宽度和连续性。与一组接受持续阻力病变的PVI的患者(n=20)进行比较。逐点组术后平均瘢痕负担和瘢痕宽度明显低于对照组(6.66.8%vs.9.6+/-5.0%，P=0.03和7.9+/-3.6 mm vs.10.7±-2.3 mm，P=0.003)。逐点组双侧肺静脉环更完整(P=0.038)。所有患者均获得急性PVI。结论采用逐点肺静脉隔离的方法是可行的，与传统的阻力损伤方法相比，可减少瘢痕负担和减少瘢痕宽度，使肺静脉形成更完整的环。
Aims A point-by-point workflow for pulmonary vein isolation (PVI) targeting pre-defined Ablation Index values (a composite of contact force, time, and power) and minimizing interlesion distance may optimize the creation of contiguous ablation lesions whilst minimizing scar formation. We aimed to compare ablation scar formation in patients undergoing PVI using this workflow to patients undergoing a continuous catheter drag workflow.Methods and results Post-ablation cardiovascular magnetic resonance imaging was performed in patients undergoing 1st-time PVI using a parameter-guided point-by-point workflow (n = 26). Total left atrial scar burden and the width and continuity of the pulmonary vein encirclement were determined on analysis of atrial late gadolinium enhancement sequences. Comparison was made with a cohort of patients (n = 20) undergoing PVI using continuous drag lesions. Mean post-ablation scar burden and scar width were significantly lower in the point-by-point group than in the control group (6.66.8% vs. 9.6 +/- 5.0%, P = 0.03 and 7.9 +/- 3.6 mm vs. 10.7 +/- 2.3 mm, P = 0.003). More complete bilateral pulmonary vein encirclements were seen in the point-by-point group (P = 0.038). All patients achieved acute PVI.Conclusion Pulmonary vein isolation using a point-by-point workflow is feasible and results in a lower scar burden and scar width with more complete pulmonary vein encirclements than a conventional drag lesion approach.