高功率上腔静脉电隔离的量化消融研究

Investigation of quantitative ablation of electrical isolation of superior vena cava with high power

目的 探索高功率射频消融进行上腔静脉电隔离(SVCI)的目标量化消融参数(AI)值及其安全性和有效性。方法 选取2020年10月至2022年3月期间在中国医学科学院阜外医院和云南省阜外心血管病医院住院的临床心电图与心内电生理考虑上腔静脉触发房颤的90例房颤患者。其中2021年8月之前44例患者为探索组患者,之后的46例患者为验证组患者。首先在探索组房颤患者中以右心房-上腔静脉电传导突破点为指导进行高功率(40 W)射频消融完成SVCI。随后通过离线分析在上腔静脉不同节段的AI值并确定目标AI值范围。最后在验证组房颤患者中以该目标AI值为指导进行SVCI并辅以腺苷试验验证其有效性和安全性。结果 90例患者纳入研究(探索组44例,验证组46例)。65例(72.2%)患者采用节段性消融策略,两组患者在消融节段数量与比例上没有统计学差异。根据探索组AI值离线分析结果拟定目标AI值范围为350~400。在验证组中采用该目标AI值指导下进行射频消融完成SVCI的即刻成功率明显高于探索组(100%比90.9%,P=0.0364),且无并发症发生。验证组的AI值明显高于探索组[(378±44)比(317±54),P<0.001],腺苷试验结果发现SVC电传导恢复率明显低于肺静脉(4.35%比19.6%)。结论 采用目标AI值(350~400)进行高功率射频消融完成SVCI是安全、有效的。

Objective To investigate the quantitative ablation index(AI)value during superior vena cava electrical isolation(SVCI)by radiofrequency ablation with high power.Methods Ninety patients with clinical ECG and intracardiac electrophysiology considering superior vena cava-triggered atrial fibrillation(AF)were admitted to Fu Wai Hospital,Chinese Academy of Medical Sciences and Fu Wai Cardiovascular Hospital,Yunnan Province between October 2020 and March 2022.Among the patients,44 before August 2021 were in the exploratory group and 46 patients afterwards were in the validation group.First,in the exploratory group,the radiofrequency ablation with 40W was performed to complete SVCI guided by the conduction breakthrough point from the right atrium to SVC.Then,the target range of AI value was calculated by an off-line analysis of radiofrequency ablation energy in different segments of SVC.Last,the safety and effectiveness of SVCI under the strategy with the target range of AI value were evaluated in the validation group with an additional adenosine test.Results Ninety patients were included in the study(44 in the development group/46 in the validation group).The segmental ablation strategy was used in 65 patients(72.2%)and there was no statistical difference in the number and proportion of ablation segments between the two groups.According to the offline analysis of the AI values of the development group,the target AI value range was set as 350-400.The immediate success rate of SVCI with the range of targeted AI value in the validation group was significantly higher than that in the exploration group(100%vs 90.9%,P=0.0364)and no complications occurred in the validation group.The average AI value in the validation group was significantly higher than that in the development group(378±44 vs 317±54,P<0.001).During the adenosine test,the recovery rate of electrical conduction in SVC was significantly lower than that in the pulmonary vein(4.35%vs 19.6%).Conclusion The target AI value with range from 350 to 400 is safe and effective for high-power radiofrequency ablation to complete SVCI.