背景:肺静脉(PV)的最佳闭塞对于心房颤动(AF)冷冻球囊消融(CBA)至关重要。该研究的目的是研究在CBA程序中使用新型导航系统评估PV闭塞的两种不同工具的性能。
方法:在新型三维标测系统的指导下接受CBA手术的连续阵发性房颤患者,基线工具,注射工具和肺静脉造影均用于评估肺静脉闭塞程度,并记录相应的冷冻消融参数。
结果:在23例患者中(平均年龄60.0±13.9岁,56.5%男性),在92个PVs中共进行了149次封堵尝试和122次冷冻消融.以肺静脉造影作为金标准,整体灵敏度,基线工具的特异性为96.7%(95%置信区间[CI]90.0%-99.1%),和40.5%(95%CI26.0%-56.7%),分别,而注射工具的相应值为69.6%(95%CI59.7%-78.1%),和100.0%(95%CI90.6%-100.0%),分别。最佳封堵冷冻消融显示较低的最低点温度(基线工具:-44.3±8.4°Cvs.-35.1±6.5°C,p<.001;注射工具:-46.7±6.4°Cvs.-38.3±9.2°C,p<.001)和更长的总解冻时间(基线工具:53.3±17.0svs.38.2±14.9s,p=.003;注射工具:58.5±15.5svs.41.7±15.2s,p<.001)与没有的相比。
结论:两种工具都能够准确评估肺静脉闭塞程度并预测急性冷冻消融效果,基线工具更敏感,注射工具更具体。
Optimal occlusion of pulmonary vein (PV) is essential for atrial fibrillation (AF) cryoballoon ablation (CBA). The aim of the study was to investigate the performance of two different tools for the assessment of PV occlusion with a novel navigation system in CBA procedure.
In consecutive patients with paroxysmal AF who underwent CBA procedure with the guidance of the novel 3-dimentional mapping system, the baseline tool, injection tool and pulmonary venography were all employed to assess the degree of PV occlusion, and the corresponding cryoablation parameters were recorded.
In 23 patients (mean age 60.0 ± 13.9 years, 56.5% male), a total of 149 attempts of occlusion and 122 cryoablations in 92 PVs were performed. Using pulmonary venography as the gold standard, the overall sensitivity, specificity of the baseline tool was 96.7% (95% confidence interval [CI] 90.0%-99.1%), and 40.5% (95% CI 26.0%-56.7%), respectively, while the corresponding value of the injection tool was 69.6% (95% CI 59.7%-78.1%), and 100.0% (95% CI 90.6%-100.0%), respectively. Cryoablation with optimal occlusion showed lower nadir temperature (baseline tool: -44.3 ± 8.4°C vs. -35.1 ± 6.5°C, p < .001; injection tool: -46.7 ± 6.4°C vs. -38.3 ± 9.2°C, p < .001) and longer total thaw time (baseline tool: 53.3 ± 17.0 s vs. 38.2 ± 14.9 s, p = .003; injection tool: 58.5 ± 15.5 s vs. 41.7 ± 15.2 s, p < .001) compared with those without.
Both tools were able to accurately assess the degree of PV occlusion and predict the acute cryoablation effect, with the baseline tool being more sensitive and the injection tool more specific.