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脉冲场切除除肺静脉外的持续性心房动:疗效和对左心房功能的影响
Wael Zaher1,2,3, Lorenzo Marcon1,2, Domenico G Della Rocca2,4
1Department of Cardiology, Centre Hospitalier EpiCURA, Hornu, Belgium.
概括
对持续性心房动 (AF) 进行脉冲场切除 (PFA) 是安全有效的,可以实现高心律失常. 这种新的疗法可以改善心脏功能,而不会对左心房顺应产生负面影响.
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:
- 脉冲场移除 (PFA) 是一种用于心房动 (AF) 导管移除的新型非热能源.
- PFA选择性地准心肌细胞,最大限度地降低了附带损害.
- 由于安全性和左心房硬化 (LA) 综合征的担忧,肺静脉 (PVs) 以外的持久性AF (PersAF) 的策略正在讨论中.
研究的目的:
- 评估PFA的安全性和有效性,针对PersAF患者的肺外静脉 (PV外) 部位.
- 评估PFA对心律失常自由和左心房 (LA) 功能的影响.
- 为了确定是否广泛的PFA影响LA合规性和心脏重塑.
主要方法:
- 一项前性研究包括93名PersAF患者,他们首次接受了针对PV和PV外部位的PFA.
- 随访评估包括AF症状,不良事件,心电图和1,6个月和12个月的心声图.
- 额外的PV目标包括后壁,前面的屋顶,心肌峡,前壁和右心房.
主要成果:
- 观察到高1年无心脏节律失常 (82.8%).
- 没有发生与程序相关的严重不良事件.
- PFA改变了额头流入模式和E/A比率,但没有改变LA合规标记;然而,LA刚度指数 (LASI) 和左心室射出分数在3个月以上的患者中得到改善.
结论:
- 使用多电极导管的广泛PFA在PersAF患者中实现了高1年的心律失常自由.
- 用PFA进行额外PV切除是安全的,并且不会影响LA的遵守.
- PFA促进了积极的反向重塑,改善了LA合规性和左心室缩功能.
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