<br>通过多电极射频球囊导管进行后壁隔离：可行性、技术考虑、内窥镜检查结果以及与冷冻球囊技术的比较,Journal of Interventional Cardiac Electrophysiology

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通过多电极射频球囊导管进行后壁隔离：可行性、技术考虑、内窥镜检查结果以及与冷冻球囊技术的比较
Journal of Interventional Cardiac Electrophysiology ( IF 2.1 ) Pub Date : 2023-04-27 , DOI: 10.1007/s10840-023-01549-1
Alvise Del Monte ₁ , Gian Battista Chierchia ₁ , Domenico Giovanni Della Rocca _{1,

2} , Luigi Pannone ₁ , Antonio Sorgente ₁ , Gezim Bala ₁ , Cinzia Monaco ₁ , Sahar Mouram ₁ , Lucio Capulzini Cremonini ₁ , Charles Audiat ₁ , Joke Praet ₃ , Robbert Ramak ₁ , Ingrid Overeinder ₁ , Erwin Ströker ₁ , Juan Sieira ₁ , Mark La Meir ₄ , Pedro Brugada ₁ , Andrea Sarkozy ₁ , Carlo de Asmundis ₁ , Alexandre Almorad ₁

Affiliation

背景

后壁（PW）隔离是非阵发性心房颤动（AF）患者的重要辅助消融目标。传统上采用逐点射频 (RF) 消融进行，PW 隔离也采用不同的冷冻球囊技术进行。我们的目的是评估使用新型射频球囊导管 Heliostar™（Biosense Webster，加利福尼亚州，美国）进行 PW 分离的可行性。

方法

我们前瞻性地连续招募了 32 名持续性 AF 患者，计划使用 Heliostar™ 设备进行首次消融。将程序数据与来自 96 名连续接受肺静脉 (PV) 加冷冻球囊装置 PW 隔离的持续性 AF 患者的数据进行比较。对于参与研究的每位操作员来说，射频球囊/冷冻球囊的比例为1:3，旨在避免因经验不同而出现任何不平衡。

结果

与冷冻球囊消融相比，使用射频球囊技术进行单次 PV 隔离的病例数量显着增加（分别为 89.8% 和 81.0%； p = 0.02）。两组之间的球囊应用次数相似（射频球囊 11 ± 4 次，冷冻球囊 11 ± 2 次； p = 0.16），但射频球囊患者的时间明显更短（228 ± 72 s 与冷冻球囊 1274 ± 277 s 相比； p < 0.001)。主要安全终点没有发生在 RF 球囊患者中，而冷冻球囊组中有 5 名患者 (5.2%) 发生 ( p = 0.33)。所有 (100%) 射频球囊患者均达到主要疗效终点，而使用冷冻球囊患者则为 93 例 (96.9%) ( p = 0.57)。食管内窥镜检查未显示射频球囊患者出现任何管腔温度升高的热损伤迹象。

结论

与类似的基于冷冻球囊的消融手术相比，基于射频球囊的 PW 隔离是安全的，并且可以缩短手术时间。

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Posterior wall isolation via a multi-electrode radiofrequency balloon catheter: feasibility, technical considerations, endoscopic findings and comparison with cryoballoon technologies

Background

Posterior wall (PW) isolation is an important adjunctive ablation target in patients with non-paroxysmal atrial fibrillation (AF). Traditionally performed with point-by-point radiofrequency (RF) ablation, PW isolation has also been performed with different cryoballoon technologies. We aimed at assessing the feasibility of PW isolation with the novel RF balloon catheter Heliostar™ (Biosense Webster, CA, USA).

Methods

We prospectively enrolled 32 consecutive patients with persistent AF scheduled for first-time ablation with the Heliostar™ device. Procedural data were compared with those from 96 consecutive persistent AF patients undergoing pulmonary vein (PV) plus PW isolation with a cryoballoon device. The ratio RF balloon/cryoballoon was 1:3 for each operator involved in the study, aiming at avoiding any imbalance related to different experience.

Results

Single-shot PV isolation was documented in a significantly higher number of cases with the RF balloon technology compared to cryoballoon ablation (89.8% vs. 81.0%; p = 0.02, respectively). PW isolation was achieved with a similar number of balloon applications between the two groups (11 ± 4 with the RF balloon versus 11 ± 2 with the cryoballoon; p = 0.16), but in a significantly shorter time among RF balloon patients (228 ± 72 s versus 1274 ± 277 s with cryoballoon; p < 0.001). Primary safety endpoint occurred in none of the RF balloon patients versus 5 (5.2%) patients in the cryoballoon group (p = 0.33). Primary efficacy endpoint was achieved in all (100%) RF balloon patients versus 93 (96.9%) cryoballoon ones (p = 0.57). Oesophageal endoscopy did not show any signs of thermal lesions in RF balloon patients with luminal temperature rise.