轴支撑消融导管在猪右上肺静脉标测和消融的操控性研究

A novel wire-guided ablation catheter for ablation of right superior pulmonary vein in experimental pigs

目的在左房内精准有效操控消融导管是保证心房颤动(简称房颤)消融高效成功的技术关键。我们根据圆规画圆原理设计了新型轴支撑消融导管,本实验拟验证其是否具有精准有效的操控性。方法将同一实验动物先后随机分入实验组和对照组,分别采用轴支撑冷盐水灌注消融导管(轴支撑组)和非轴支撑冷盐水灌注消融导管(非轴支撑组)进行右上肺静脉标测/消融操作。将轴支撑导管的轴支撑钢丝撤回钢丝腔内即成为非轴支撑导管。采用EnSite Velocity^(TM)心脏三维标测系统重建左房及右上肺静脉。实验内容包括导管在右上肺静脉邻近区域的贴靠标测及标测消融两部分。结果 8只动物中,房间隔穿刺致2例动物心包压塞,1例死亡,7例动物完成实验程序。在贴靠标测实验中,轴支撑组完成环肺静脉间断贴靠、环肺静脉连续贴靠和肺静脉前庭放射状线性连续贴靠的操作时间和曝光时间分别显著少于非轴支撑组(P均<0.001);在标测消融实验中,完成环肺静脉消融和肺静脉前庭放射状线性消融的操作时间和曝光时间分别显著少于非轴支撑组(P均<0.001)。在左房操作过程中,轴支撑组不经意退回右房的次数显著少于非轴支撑组[(0.7±0.8)次vs(5.1±1.3)次,P<0.001];轴支撑组从原房间隔穿刺孔再进入左房的时间显著少于非轴支撑组[(1.0±0.2)min vs(5.0±0.9)min,P<0.001]。动物解剖未见留置在肺静脉及左房内的导引钢丝表面及导管钢丝腔开口有血栓附着,右上肺静脉内膜未见划痕、撕裂和血栓附着。结论轴支撑消融导管的操控性能明显优于非轴支撑导管。轴支撑导管的移动方向及移动距离易于控制,到位精准,贴靠标测稳定,具有较高的安全性。

Objective Effective manipulation of ablation catheter in left atrium （LA） is the most critical to ensure the success and efficiency of atrial fibrillation （AF） ablation. A novel wire-guided ablation catheter based on the principle of compass may be more helpful to simplify the manipulation and improve the accuracy of positioning and con- tacting for ablation catheter. Methods The same animal was randomized successively into the experimental group and control group during the procedure , in which the wire - guided ablation catheter and the conventional saline - irrigated ablation catheter （non-wire-guided ablation catheter） were used separately. The wire-guided ablation catheter was made from a saline-irrigated ablation catheter com- bined with a guide-wire, which could be taken out from the catheter.The LA and right superior pulmonary vein （RSPV） were reconstructed with EnSite VelocityTM mapping system. The experiment protocol included contact/mapping and contact/ablation in antrum of RSPV. Results Eight pigs were used , pericardial tamponade occurred to two animals, one of which died, and seven animals experienced the protocol. By using the wire-guided ablation catheter compared with the non-wire-guided ablation catheter, the contact/mapping at four sep- arated sites, the circumference and theantral radial-lines in RSPV took significantly shorter procedure time and ex posure time respectively （all P 〈0.001 ）, and the circumferential RSPV ablation and the antrial radial-linear ablation took significantly shorter procedure time and exposure time, too （all P 〈 0.001）.During the procedure, the wire- guided ablation catheter had unintentionally fallen into right atrium for （0.7 ± 0.8） times compared to （ 5.1 ± 1.3） times for the non-wire-guided ablation catheter （P〈0.001）; it took （1.0±0.2） min for the wire-guided ablation catheter and （5.0±0.9） min for the non-wire-guided ablation catheter（P〈0.001） to be positioned again into LA from the previous atrial septal puncture. No thrombosis was found on the guide-wire and the distal hole of the guide- wire lumen, and no scratches, tears and thrombus found in RSPV intima. Conclusion The study demonstrated that the wire-guided ablation catheter is better manipulated than the non-wire-guided ablation catheter.The direction and distance of catheter moving can be easily controlled, precisely positioned and stably contacted for the wire-guided ablation catheter and with more safety.