PDF(Pubmed)
Abstract：
OBJECTIVE: A pulsed electric field (PF) energy source is a novel potential option for catheter ablation of ventricular arrhythmias (VAs) as it can create deeper lesions, particularly in scarred tissue. However, very limited data exist on its efficacy and safety. This prospective observational study reports the initial experience with VA ablation using focal PF.
RESULTS: The study population consisted of 44 patients (16 women, aged 61 ± 14years) with either frequent ventricular premature complexes (VPCs, 48%) or scar-related ventricular tachycardia (VT, 52%). Ablation was performed using an irrigated 4 mm tip catheter and a commercially available PF generator. On average, 16 ± 15 PF applications (25 A) were delivered per patient. Acute success was achieved in 84% of patients as assessed by elimination of VPC or reaching non-inducibility of VT. In three cases (7%), a transient conduction system block was observed during PF applications remotely from the septum. Root analysis revealed that this event was caused by current leakage from the proximal shaft electrodes in contact with the basal interventricular septum. Acute elimination of VPC was achieved in 81% patients and non-inducibility of VT in 83% patients. At the 3-month follow-up, persistent suppression of the VPC was confirmed on Holter monitoring in 81% patients. In the VT group, the mean follow-up was 116 ± 75 days and a total of 52% patients remained free of any VA.
CONCLUSIONS: Pulsed electric field catheter ablation of a broad spectrum of VA is feasible with acute high efficacy; however, the short-term follow-up is less satisfactory for patients with scar-related VT.
RESULTS: The study population consisted of 44 patients (16 women, aged 61 ± 14years) with either frequent ventricular premature complexes (VPCs, 48%) or scar-related ventricular tachycardia (VT, 52%). Ablation was performed using an irrigated 4 mm tip catheter and a commercially available PF generator. On average, 16 ± 15 PF applications (25 A) were delivered per patient. Acute success was achieved in 84% of patients as assessed by elimination of VPC or reaching non-inducibility of VT. In three cases (7%), a transient conduction system block was observed during PF applications remotely from the septum. Root analysis revealed that this event was caused by current leakage from the proximal shaft electrodes in contact with the basal interventricular septum. Acute elimination of VPC was achieved in 81% patients and non-inducibility of VT in 83% patients. At the 3-month follow-up, persistent suppression of the VPC was confirmed on Holter monitoring in 81% patients. In the VT group, the mean follow-up was 116 ± 75 days and a total of 52% patients remained free of any VA.
CONCLUSIONS: Pulsed electric field catheter ablation of a broad spectrum of VA is feasible with acute high efficacy; however, the short-term follow-up is less satisfactory for patients with scar-related VT.
摘要：
目的：脉冲电场（PF）能量源是室性心律失常（VA）导管消融的一种新颖的潜在选择，因为它可以产生更深的病变，特别是在有疤痕的组织中。然而,关于其疗效和安全性的数据非常有限.这项前瞻性观察性研究报告了使用局灶性PF进行VA消融的初始经验。
方法：研究人群包括44名患者（16名女性，年龄61±14岁），有频发的室性早搏（VPC）（48％）或疤痕相关性室性心动过速（VT）（52％）。使用灌注的4毫米尖端导管和市售PF发生器进行消融。
结果：平均而言，每位患者实施16±15PF应用(25A)。通过消除VPC或达到不可诱发性VT评估，84％的患者获得了急性成功。在3例（7%）中，在远离隔膜的PF应用期间观察到瞬时传导系统阻滞。根分析显示，此事件是由与基底室间隔接触的近端轴电极的电流泄漏引起的。81％的患者实现了VPC的急性消除，而83％的患者实现了VT的非诱导性。在三个月的随访中，在动态心电图监测中,81%的患者证实了VPC的持续抑制.在VT组中,平均随访时间为116±75天,共有52%的患者没有任何VA.
结论：PF导管消融广谱VA是可行的，急性高疗效，然而,对于瘢痕相关性VT患者,短期随访效果较差.
方法：研究人群包括44名患者（16名女性，年龄61±14岁），有频发的室性早搏（VPC）（48％）或疤痕相关性室性心动过速（VT）（52％）。使用灌注的4毫米尖端导管和市售PF发生器进行消融。
结果：平均而言，每位患者实施16±15PF应用(25A)。通过消除VPC或达到不可诱发性VT评估，84％的患者获得了急性成功。在3例（7%）中，在远离隔膜的PF应用期间观察到瞬时传导系统阻滞。根分析显示，此事件是由与基底室间隔接触的近端轴电极的电流泄漏引起的。81％的患者实现了VPC的急性消除，而83％的患者实现了VT的非诱导性。在三个月的随访中，在动态心电图监测中,81%的患者证实了VPC的持续抑制.在VT组中,平均随访时间为116±75天,共有52%的患者没有任何VA.
结论：PF导管消融广谱VA是可行的，急性高疗效，然而,对于瘢痕相关性VT患者,短期随访效果较差.
