Long-term clinical outcome following pulmonary vein isolation with high-intensity focused ultrasound balloon catheters in patients with paroxysmal atrial fibrillation
Long-term clinical outcome following pulmonary vein isolation with high-intensity focused ultrasound balloon catheters in patients with paroxysmal atrial fibrillation
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DOI：
10.1093/europace/eup416
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发表时间：
2010-02-01
期刊：
影响因子：
6.1
通讯作者：
Schmidt, Boris
中科院分区：
文献类型：
--
作者：
Metzner, Andreas;Chun, K. R. Julian;Schmidt, Boris
通过球囊导管应用高强度聚焦超声 (HIFU) 是一种用于阵发性心房颤动 (PAF) 患者肺静脉隔离 (PVI) 的新技术。长期成功率未知。 32 名患者（22 名男性，年龄 60 +/- 9 岁）具有长期药物难治性 [3 +/- 1 种抗心律失常药物 (AAD)]、有症状的 PAF 病史 [5 (4;9) 年] 纳入分析。使用第一代和第二代 HIFU 球囊导管（ProRhythm(R), Ronkonkoma, NY, USA）进行肺静脉隔离。随访 (F/U) 包括定期电话访谈、电话动态心电图和事件记录。复发定义为记录在案的或有症状的 AF 发作 > 30 秒且无空白期。总共 101/116 个目标 PV（87%）仅使用 HIFU 进行了急性分离。在中位 F/U 为 1400 (930;1568) 天期间，18 名患者 (56%) 在单次 HIFU 手术后没有出现 AAD 的 AF。在 9 名 AF 复发患者中，20 个 PV 表现出电再传导，并使用灌注射频电流 (RFC) 消融进行了重新隔离。因症状性 PAF 而使用第一代和第二代 HIFU 球囊导管治疗的患者显示出与基于 RFC 的 PVI 手术相似的长期成功率。 HIFU 治疗后 AF 复发的主要决定因素似乎是先前孤立的 PV 的再传导。然而，良好的疗效被 HIFU 治疗后报告的严重并发症所抵消。这导致其临床使用停止。
High-intensity focused ultrasound (HIFU) applied via a balloon catheter is a novel technology for pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF). The long-term success rate is unknown.Thirty-two patients (22 male, age 60 +/- 9 years) with a long history [5 (4;9) years] of drug refractory [3 +/- 1 anti-arrhythmic drugs (AADs)], symptomatic PAF were included into the analysis. Pulmonary vein isolation was performed using the first- and second-generation HIFU balloon catheters (ProRhythm((R)), Ronkonkoma, NY, USA). Follow-up (F/U) included regular telephonic interviews, trans-telephonic Holter ECG, and event recording. Recurrence was defined as a documented or symptomatic AF episode > 30 s without a blanking period. In total 101/116 targeted PVs (87%) were acutely isolated exclusively using HIFU. During a median F/U of 1400 (930;1568) days, 18 patients (56%) were free of AF without AAD after a single HIFU procedure. In nine patients with AF recurrence, 20 PVs exhibited electrical reconduction and re-isolation was performed using irrigated radiofrequency current (RFC) ablation.Patients treated with the first- and second-generation HIFU balloon catheters due to symptomatic PAF show long-term success rates similar to RFC-based PVI procedures. The major determinant of AF recurrence after HIFU treatment seems to be reconduction of previously isolated PVs. However, the favourable effectiveness is offset by the severe complications reported following HIFU treatment. This led to a halt of its clinical use.