Advances in high-power short-duration quantitative radiofrequency ablation of atrial fibrillation
-
摘要: 肺静脉隔离是心房颤动消融治疗的基石。既往消融方式复杂耗时且远期复发率较高。消融指数和损伤指数为综合了消融功率、时间和压力的量化参数，其指导下的高功率短时程射频消融能显著缩短手术、消融时长，损伤效果更为持久。本综述旨在简述心房颤动射频消融治疗现况及主要挑战，并评估量化参数指导下高功率短时程消融策略的临床疗效和安全性。Abstract: Pulmonary vein isolation is the cornerstone of atrial fibrillation ablation therapy. However, conventional ablation therapy is complicated and time-consuming, with disappointing long-term recurrence clinical outcomes. There are two surrogate endpoints in which contain complex mathematical formulas. Ablation index and lesion size index are the quantitative parameters corporating ablation power, contact force, and duration of ablation delivery. Both can effectively guide the clinician to achieve transmural lesions with high-power short-duration radiofrequency ablation, significantly shortening the duration of surgery and ablation. The purpose of this review is to summarize the current status and main challenges of radiofrequency ablation for atrial fibrillation and to evaluate the clinical efficacy and safety of the high-power short-duration ablation strategy under the guidance of quantitative parameters.
-
-
[1] Burdett P, Lip GYH. Atrial fibrillation in the united kingdom: Predicting costs of an emerging epidemic recognising and forecasting the cost drivers of atrial fibrillation-related costs[J]. European Heart Journal Quality of Care & Clinical Outcomes, 2020, 111: 100.
[2] 黎凯锋, 田灿辉, 潘俊安, 等. 他汀类药物对房颤相关性急性缺血性脑卒中患者血浆Ox-LDL水平的影响及预后研究[J]. 临床急诊杂志, 2020, 21(12): 982-986. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202012011.htm
[3] Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins[J]. N Engl J Med, 1998, 339(10): 659-666. doi: 10.1056/NEJM199809033391003
[4] Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies[J]. Nat Rev Cardiol, 2021, 18(3): 210-225. doi: 10.1038/s41569-020-00451-x
[5] January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation[J]. J Am Coll Cardiol, 2019, 74(1): 104-132. doi: 10.1016/j.jacc.2019.01.011
[6] Reddy VY, Dukkipati SR, Neuzil P, et al. Randomized, controlled trial of the safety and effectiveness of a contact force-sensing irrigated catheter for ablation of paroxysmal atrial fibrillation: Results of the tacticath contact force ablation catheter study for atrial fibrillation(toccastar)study[J]. Circulation, 2015, 132(10): 907-915. doi: 10.1161/CIRCULATIONAHA.114.014092
[7] Ullah W, Mclean A, Tayebjee MH, et al. Randomized trial comparing pulmonary vein isolation using the smarttouch catheter with or without real-time contact force data[J]. Heart rhythm, 2016, 13(9): 1761-1767. doi: 10.1016/j.hrthm.2016.05.011
[8] Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert consensus statement on catheter and surgical ablation of atrial fibrillation[J]. Heart rhythm, 2017, 14(10): e275-e444.
[9] De Pooter J, Strisciuglio T, Haddad ME, et al. Pulmonary vein reconnection no longer occurs in the majority of patients after a single pulmonary vein isolation procedure[J]. JACC Clinical Electrophysiology, 2019, 5(3): 295-305. doi: 10.1016/j.jacep.2018.11.020
[10] Winkle RA, Mohanty S, Patrawala RA, et al. Low complication rates using high power(45-50 W)for short duration for atrial fibrillation ablations[J]. Heart Rhythm, 2019, 16(2): 165-169. doi: 10.1016/j.hrthm.2018.11.031
[11] Leshem E, Zilberman I, Tschabrunn CM, et al. High-power and short-duration ablation for pulmonary vein isolation: biophysical characterization[J]. JACC Clin Electrophysiol, 2018, 4(4): 467-479. doi: 10.1016/j.jacep.2017.11.018
[12] Kottmaier M, Popa M, Bourier F, et al. Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation[J]. Europace, 2020, 22(3): 388-393. doi: 10.1093/europace/euz342
[13] Reddy VY, Grimaldi M, De Potter T, et al. Pulmonary vein isolation with very high power, short duration, temperature-controlled lesions: The QDOT-FAST Trial[J]. JACC Clin Electrophysiol, 2019, 5(7): 778-786. doi: 10.1016/j.jacep.2019.04.009
[14] Wittkampf FH, Nakagawa H. RF catheter ablation: Lessons on lesions[J]. Pacing Clin Electrophysiol, 2006, 29(11): 1285-1297. doi: 10.1111/j.1540-8159.2006.00533.x
[15] Bourier F, Duchateau J, Vlachos K, et al. High-power short-duration versus standard radiofrequency ablation: Insights on lesion metrics[J]. J Cardiovasc Electrophysiol, 2018, 29(11): 1570-1575. doi: 10.1111/jce.13724
[16] Ali-Ahmed F, Goyal V, Patel M, et al. High-power, low-flow, short-ablation duration-the key to avoid collateral injury?[J]. J Interv Card Electrophysiol, 2019, 55(1): 9-16. doi: 10.1007/s10840-018-0473-5
[17] Bhaskaran A, Chik W, Pouliopoulos J, et al. Five seconds of 50-60 W radio frequency atrial ablations were transmural and safe: an in vitro mechanistic assessment and force-controlled in vivo validation[J]. Europace, 2017, 19(5): 874-880.
[18] Borne RT, Sauer WH, Zipse MM, et al. Longer duration versus increasing power during radiofrequency ablation yields different ablation lesion characteristics[J]. JACC Clin Electrophysiol, 2018, 4(7): 902-908. doi: 10.1016/j.jacep.2018.03.020
[19] Barkagan M, Contreras-Valdes FM, Leshem E, et al. High-power and short-duration ablation for pulmonary vein isolation: Safety, efficacy, and long-term durability[J]. J Cardiovasc Electrophysiol, 2018, 29(9): 1287-1296. doi: 10.1111/jce.13651
[20] Oral H, Scharf C, Chugh A, et al. Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation[J]. Circulation, 2003, 108(19): 2355-2360. doi: 10.1161/01.CIR.0000095796.45180.88
[21] Nilsson B, Chen X, Pehrson S, et al. The effectiveness of a high output/short duration radiofrequency current application technique in segmental pulmonary vein isolation for atrial fibrillation[J]. Europace, 2006, 8(11): 962-965. doi: 10.1093/europace/eul100
[22] Vassallo F, Cunha C, Serpa E, et al. Comparison of high-power short-duration(HPSD)ablation of atrial fibrillation using a contact force-sensing catheter and conventional technique: Initial results[J]. J Cardiovasc Electrophysiol, 2019, 30(10): 1877-1883. doi: 10.1111/jce.14110
[23] Yavin HD, Leshem E, Shapira-Daniels A, et al. Impact of high-power short-duration radiofrequency ablation on long-term lesion durability for atrial fibrillation ablation[J]. JACC Clinical electrophysiology, 2020, 6(8): 973-985. doi: 10.1016/j.jacep.2020.04.023
[24] Chen S, Schmidt B, Bordignon S, et al. Ablation index-guided 50 W ablation for pulmonary vein isolation in patients with atrial fibrillation: Procedural data, lesion analysis, and initial results from the FAFA AI High Power Study[J]. J Cardiovasc Electrophysiol, 2019, 30(12): 2724-2731. doi: 10.1111/jce.14219
[25] Okamatsu H, Koyama J, Sakai Y, et al. High-power application is associated with shorter procedure time and higher rate of first-pass pulmonary vein isolation in ablation index-guided atrial fibrillation ablation[J]. J Cardiovasc Electrophysiol, 2019, 30(12): 2751-2758. doi: 10.1111/jce.14223
[26] Shin DG, Ahn J, Han SJ, et al. Efficacy of high-power and short-duration ablation in patients with atrial fibrillation: a prospective randomized controlled trial[J]. Europace, 2020, 22(10): 1495-1501. doi: 10.1093/europace/euaa144
[27] Leo M, Pedersen M, Rajappan K, et al. Power, lesion size index and oesophageal temperature alerts during atrial fibrillation ablation: A Randomized Study[J]. Circ Arrhythm Electrophysiol, 2020, 13(10): e008316.
[28] Baher A, Kheirkhahan M, Rechenmacher SJ, et al. High-power radiofrequency catheter ablation of atrial fibrillation: using late gadolinium enhancement magnetic resonance imaging as a novel index of esophageal injury[J]. JACC Clin Electrophysiol, 2018, 4(12): 1583-1594. doi: 10.1016/j.jacep.2018.07.017
[29] Kaneshiro T, Kamioka M, Hijioka N, et al. Characteristics of esophageal injury in ablation of atrial fibrillation using a high-power short-duration setting[J]. Circ Arrhythm Electrophysiol, 2020, 13(10): e008602.
[30] Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage isolation in patients with longstanding persistent af undergoing catheter ablation: BELIEF Trial[J]. J Am Coll Cardiol, 2016, 68(18): 1929-1940. doi: 10.1016/j.jacc.2016.07.770
[31] Sairaku A, Yoshida Y, Nakano Y, et al. Who is the operator, that is the question: a multicentre study of catheter ablation of atrial fibrillation[J]. Europace, 2016, 18(9): 1352-1356. doi: 10.1093/europace/euv424
[32] Blum S, Aeschbacher S, Meyre P, et al. Incidence and predictors of atrial fibrillation progression[J]. J Am Heart Assoc, 2019, 8(20): e012554. doi: 10.1161/JAHA.119.012554
[33] Mulder MJ, Kemme M, Hopman L, et al. Comparison of the predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation[J]. Int J Cardiol, 2021, 344: 103-110. doi: 10.1016/j.ijcard.2021.09.029
[34] Middeldorp ME, Pathak RK, Meredith M, et al. Prevention and regressive effect of weight-loss and risk factor modification on atrial fibrillation: The reverse-af study[J]. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology, 2018, 20(12): 1929-1935.
[35] Deng F, Raza A, Guo J. Treating obstructive sleep apnea with continuous positive airway pressure reduces risk of recurrent atrial fibrillation after catheter ablation: a meta-analysis[J]. Sleep Med, 2018, 46: 5-11. doi: 10.1016/j.sleep.2018.02.013
-
计量
- 文章访问数: 1821
- PDF下载数: 629
- 施引文献: 0
下载: