新型Achieve环状标测导管在心房颤动冷冻消融术中的应用

Clinical application of novel Achieve circular mapping catheter in cryo-ablation of atrial fibrillation

目的探讨应用新型Achieve环状标测导管在心房颤动(AF)冷冻球囊消融(CBA)过程中,实时监测肺静脉隔离(PVI)的作用。方法回顾分析2014年5月至2014年11月,在瑞金医院使用28mm冷冻球囊(CB)进行消融的61例阵发性AF患者。房间隔穿刺后,将带有Achieve环状标测导管的CB置于左房(LA)内,进行肺静脉电位(PVP)的标测和消融。结果 61例患者的244根肺静脉中有240根(98.4%)达到成功PVI,其中196根肺静脉(80.3%)可于消融中实时监测PVI(91.8%LSPV,82.0%LIPV,86.9%RSPV,60.7%RIPV)。在可实时监测PVI的196根静脉中,按照术中LA-PV传导恢复情况分为早期传导恢复(LAPVR)组和传导未恢复(nLAPVR)组。LAPVR组的平均PVI时间为(89±39.3)s,显著长于nLAPVR组(41±17.9)s,P<0.01。且LAPVR组最低冷冻温度为(-42±4.3)℃,显著高于nLAPVR组(-48±13.3)℃,P<0.05。预测术中持续PVI最佳界值为53s(灵敏度83%,特异度75%,曲线下面积0.894,P<0.05)。结论新型Achieve环状标测导管不仅可用于判断PVI;还可以通过实时记录PVI时间,预测术中LA-PV早期传导是否容易恢复。

Objective To investigate the effect of real-time monitoring of pulmonary vein potentials（PVP） on using novel Achieve circular mapping catheter（Achieve） with cryoballon catheter in atrial fibrillation（AF） ablation. Methods From May 2014 to November 2014,61 paroxysmal AF patients （40 males） who underwent first time procedure of cryoballon ablation（CBA） were enrolled in our observational study, all CBA were carried out with 28 mm cryoballon（CB） only. After conventional transeptal puncture, the Achieve was introduced into the left atrium with cryoballon CB＇s inner lumen for the purpose of recording PVP and pulmonary vein isolation（PVI） in real-time. Results A total of 240（98.4%） PVs were completely isolated using this novel CBA approach. The Achieve was able to record PV-I in real-time in 80.3 % （196/244） of the case[91.8 % left superior pulmonary vein,82.0 % left inferior pulmonary vein,86.9% right superior pulmonary vein, 60.7 % right inferior pulmonary vein]. 196 PVs of which PVP could be recorded in real-time, were then divided into 2 groups ：early left atrium-pulmonary vein（LA-PV） reconnection（LAPVR） group and non early LA-PV reconnection（nLAPVR） group. Compared with another group, LAPVR group tend to have a longer time to achieve PVIELAPVR： （89±39.3） s ,nLAPVR： （41±17.9） s,P〈0.01）1,and a higher temperature of CB[LAPVR： （ - 42 ± 4. 3）℃, nLAPVR： （-48±13.3）℃ ,P〈0. 05）]. According to the ROC analysis,a cut off value of 53s was predictive of persistent PVI during operation with a sensitivity of 83% and specificity of 75% （area under curve =0. 894;P〈0.05）. Conclusion The novel Achieve circular mapping catheter can be used for recording PVP during CBA,the time for real-time monitoring of PVI could help to predict early LA-PV reconnection.