在心转动中优化能量传递:一种随机的PROTOCOLENERGY2个不同的算法在患有心房的患者中的随机试验
Miklik Roman1, Rucki Lucjan1, Jiravsky Otakar2
1Department of Cardiology, Nemocnice Agel Trinec-Podlesi, Trinec, Czechia.
The Canadian journal of cardiology
|June 10, 2024
概括
理性与最大固定能量 (PROTOCOLENERGY) 试验发现,对于心房动心转变的两种能量协议同样有效. 然而,随着最初150-J冲击的逐步升级能量算法 (RaA) 减少了皮肤并发症,特别是在体重指数较低的患者中.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 医疗器械 医疗器械
背景情况:
- 在心房动中,用于直流心脏转换的最佳能量方案尚未确立.
- 在PROTOCOLENERGY试验中,研究了两种能源输送策略:一个逐步升级的算法 (RaA) 和一个最大固定能量算法 (MfA).
研究的目的:
- 为了比较RaA与MFA对心房动直流心脏转变的疗效和安全性.
- 为了评估1分钟后鼻节律和2小时后神经复杂症的初级终点.
- 评估二次终点,包括持续的鼻节律,皮肤变化和胸部不适.
主要方法:
- 一个1:1随机试验,涉及300名心房的患者.
- 双相电放电通过手持在前侧位置传递.
- RaA (150 J,360 J,360 J) 与MFA (3 x 360 J) 的比较.
主要成果:
- 两种方案都显示了高和相似的达到1分钟 (92.7%的RAA与94.0%的MFA) 和2小时 (91.3%).
- 在这两组中都没有报告神经系统并发症.
- 与MFA相比,RaA协议导致皮肤发红并发症显著减少 (19.3%与36.0%相比),与较低的初始冲击能量和总能量交付有关.
- 下体质指数 (<29-34 kg/m2) 与最初的150-J冲击后的成功心脏转变有关.
结论:
- 这两种能源方案在心房动和心脏转变方面都表现出相当高的累积疗效.
- 使用初始150-J冲击的RaA协议通过减少皮肤并发症提供了好处,特别是在体重指数低于29-34kg/m2的患者中.
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