当地最大双极电压对于使用非常高功率短持续模式的优化除策略的意义
Masateru Takigawa1, Shinsuke Miyazaki1, Tasuku Yamamoto1
1Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan.
通过考虑局部电压和损伤距离等因素,可以优化用于肺静脉中隔离 (PVAI) 的非常高功率短时间 (vHPSD) 切除. 这一策略显著提高了第一次通过PVAI的成功率,并缩短了废除时间.
科学领域:
- 电子生理学 电子生理学
- 心脏切除技术的心脏切除
- 耳前的治疗方法
背景情况:
- 非常高功率短时间 (vHPSD) 切除会产生较浅的病变,可能会影响疗效.
- 肺静脉隔离 (PVAI) 是心房的关键手术.
研究的目的:
- 确定在PVAI的vHPSD-ablation过程中导致缺陷病变的因素.
- 使用vHPSD技术开发和评估一个优化的PVAI战略.
主要方法:
- 在41名AF患者使用vHPSD-ablation (90W/4s) 进行PVAI.
- 病变参数的分析,以确定缺陷病变的预测因素.
- 在42名随后的患者中测试一种优化的PVAI策略.
主要成果:
- 分析了3099个RF应用;3.3%的病变不足.
- 不足损伤的预测因素包括局部双极电压,接触力,阻抗,温度,间损伤距离 (ILD) 和解剖位置.
- 优化策略 (ILD < 4mm,特定的双V目标,HPAI) 实现了92.7%的右PV和88.1%的左PV第一通PVAI.
- 优化方法显著增加了第一通的PVI率 (p < .0001) 和减少了切除时间 (p = .04).
结论:
- 优化的vHPSD和高功率废除指数 (HPAI) 策略,以当地的双极电压和解剖学为指导,实现高的首次通过PVAI率.
- 这种方法减少了废弃时间,并最大限度地减少了能量输送.
- 这些发现支持对AF患者的vHPSD导向PVAI进行改进的策略.
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