应用自动消融标注软件分析环肺静脉消融损伤指标的差异

Analyzing the dif ferences of ablation lesion parameters of pulmonary veins isolation by using automated ablation lesion tagging software VisiTag module

目的了解心房颤动(房颤)环肺静脉消融术中不同部位消融损伤指标的差异,探讨心房-肺静脉电传导恢复的可能原因。方法入选2017年1月至2018年1月在北京大学第一医院接受初次射频消融治疗,并由同一位术者完成的房颤患者。术者应用8.5 F冷盐水灌注压力感知消融导管和自动消融损伤标注软件Visi Tag模块,在CARTO 3三维标测系统辅助下完成双侧环肺静脉消融术。术中Visi Tag模块自动标记消融损伤点并记录各消融点的平均导管-组织接触力(CF)、接触力-时间积分(FTI)等参数。术后将双侧环肺静脉消融损伤线分为8个节段,双侧共16段,分析各段消融损伤指标的差异。结果共入选28例患者,平均年龄(62.9±11.2)岁,其中男性22例(78.6%),阵发性房颤19例(67.9%)。所有手术均完成环肺静脉电隔离,共记录到2175个消融点。比较各节段消融点平均CF均值、FTI均值、平均CF<10 g的消融点百分比和FTI<400 g·s消融点百分比等指标发现,左侧肺静脉前壁各消融节段(左前上、左前中、左前下)的消融损伤指标最不理想。在自动消融损伤标注条件为逐点消融时间不少于20 s和消融时导管移动范围不超过3 mm时,各节段均显示连续出现的消融损伤点,当增设参数,消融损伤一定时间的导管-组织接触力标注所需最小CF为5 g和限定时间百分比为50%时,各节段均有自动标注的消融损伤点消失,其中仍以左前上和左前中为显著,分别达到34.5%和29.0%。结论房颤环肺静脉消融时,左肺静脉前壁CF不足、稳定性不佳。这或许是影响消融后心房-肺静脉电传导恢复的原因之一。

Objective To analyze the dif ferences of ablation lesion parameters of pulmonary vein isolation(PVI) in different segments of encircling lesion line, to look for possible causes of recovery of electric conduction between left atrium and pulmonary veins. Methods A detailed analysis was given involving the characteristics of ablation lesions of PVI for treatment of atrial ? brillation(AF)in patients without history of ablation. The data were obtained from procedures performed by the same operator from January 2017 to January 2018. An 8.5 F open-irrigated, contact force-sensing catheter and the ablation annotation system(CARTO 3 System, VisTag Module, Biosense Webster, Inc,Diamond Bar, CA) were used in all procedure for tagging ablation lesions and collecting parameters of ablation lesion, including contact force(CF), force-time integral(FTI). An encircling lesion line around ipsilateral pulmonary veins was completed for PVI. The lesion line of each pulmonary vein was divided into 8 segments for further analysis. Results A total of 28 patients, mean age(62.9±11.2)years, were enrolled, including 22 male and 19 paroxysmal AF patients. Acute PVI was achieved in all patients. Data were collected and analyzed from 2175 ablation lesions. The average values of CF and FTI were lower in left anterior segments(left anterior-superior, left anterior-middle, and left anteriorinferior). The similar situation was also found when calculating percentage of ablation lesion which met the criteria of CF<10 g and FTI<400 g · s. Although a continuous lesion line was achieved when automated tag criterion being catheter movement with a 3 mm distance limit for at least 20 s, tag points disappeared in all segments when an additional criterion of stability, force over time being minimal force5 g with 50% stability time, was used for defining the condition of automatic annotation of ablation lesion. The signi? cant segments were 34.5% in left anterior-superior and 29.0% in left anterior-middle,respectively. Conclusions Lower CF and poor stability were found in left anterior segments of encircling lesion line. This might be one of the reasons that cause recovery of electric conduction between left atrium and pulmonary veins.