背景:临床前研究表明,包括导管方向和个体射频消融期间的接触一致性等因素会影响病变大小。我们的目的是研究影响左心房(LA)导管接触的因素及其对消融的影响。
结果:在30例房颤消融术患者中研究了2,298个8秒静态LA标测点(16例房颤,14窦性心律[SR],18远程机器人导航[RRN]程序)使用接触力(CF)感测导管。CF变异性(CFV:20Hz采样的CF波形平均峰和谷之间的差异)随着平均CF而增加,斯皮尔曼的ρ=0.6,P<0.005。导管漂移与CF弱相关(Pearson相关性-0.06,P=0.005)。SR的CFV高于AF和RRN(P<0.001)。在AF中,与手动导航点相比,RRN的导管漂移较少,但SR的情况则相反。在747次静态30秒LA消融中,通过消融期间阻抗下降的多变量分析比较了接触参数对消融疗效的影响:较小的下降表明疗效降低.对于给定的力时间积分(FTI),增加的CFV(>5g)和位置漂移(>3.5mm),垂直接触,SR和RRN的使用与消融时阻抗下降较小相关(各P<0.005),提示疗效降低。
结论:除了FTI之外,导管接触质量影响消融疗效,临床导管接触受多种因素影响,包括心房节律和导管导航模式。通过与CFV≤5g的平行接触提供最大的疗效,导管漂移≤3.5mm,和手动导航。
BACKGROUND: Preclinical work suggests factors including catheter orientation and contact consistency during individual radiofrequency ablations influence lesion size. Our aim was to investigate factors affecting catheter contact in the left atrium (LA) and their effects on ablation.
RESULTS: A total of 2,298 8-second static LA mapping points were studied in 30 patients undergoing ablation for AF (16 in AF, 14 sinus rhythm [SR], 18 remote robotic navigation [RRN] procedures) using a contact force (CF) sensing catheter. CF variability (CFV: difference between 20 Hz-sampled CF waveform mean peak and trough) increased with mean CF, Spearman\'s ρ = 0.6, P < 0.005. Catheter drift correlated weakly with CF (Pearson\'s correlation -0.06, P = 0.005). CFV was higher in SR than AF and with RRN (P < 0.001). In AF, there was less catheter drift for RRN than manual navigation points but the converse was true in SR. In 747 static 30 second LA ablations, the influence of contact parameters on ablation efficacy was compared by multivariate analysis of impedance drop during ablation: a lesser drop suggesting reduced efficacy. For a given force time integral (FTI), increased CFV (>5 g) and locational drift (>3.5 mm), perpendicular contact, SR and RRN usage were associated with a lesser impedance drop with ablation (P < 0.005 for each), suggesting reduced efficacy.
CONCLUSIONS: Beyond the FTI, the quality of catheter contact influences ablation efficacy, and clinical catheter contact is affected by multiple factors, including the atrial rhythm and catheter navigation mode. Maximal efficacy is provided by parallel contact with CFV ≤5 g, catheter drift ≤3.5 mm, and manual navigation.