Optimized workflow for pulmonary vein isolation using 90-W radiofrequency applications: a comparative study.

Autor: Bortone AA; Service de Cardiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France. agubene@hotmail.com., Ramirez FD; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada., Combes S; Département de Rythmologie, Clinique Pasteur, Toulouse, France., Laborie G; Service de Cardiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France., Albenque JP; Département de Rythmologie, Clinique Pasteur, Toulouse, France., Sebag FA; Service de Cardiologie, Institut Mutualiste Montsouris, Paris, France., Limite LR; Service de Cardiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2024 Mar; Vol. 67 (2), pp. 353-361. Date of Electronic Publication: 2023 Aug 28.
DOI: 10.1007/s10840-023-01630-9
Abstrakt: Background: Ninety-watt applications are more sensitive to catheter instability and produce lesions that are shallower and smaller in diameter than 50-W applications. These characteristics were considered for the development of a combined (90-50 W) pulmonary vein isolation (PVI) strategy which was prospectively compared to a 50 W-only ablation index (AI)-guided PVI strategy.
Methods: One hundred fifty consecutive paroxysmal AF patients underwent PVI under general anesthesia using CARTO. In the first 75 patients, PVI was performed with a combined (90-50 W) strategy using the QDOT-MICRO catheter in a temperature-controlled mode. This strategy consisted of 90 W-4 s applications on the posterior LA wall (at sites of catheter stability and expectedly thin atrial tissue) with an interlesion distance (ILD) ≤ 4 mm and 50-W applications elsewhere (at sites of catheter instability or expectedly thick atrial tissue) with ILD < 6 mm. In the subsequent 75 patients, PVI was performed with a 50 W-only AI-guided strategy using the SmartTouch-SF catheter in a power-controlled mode.
Results: Both groups of patients had similar clinical characteristics and LA dimensions (123.1 ± 24.9 ml vs 119 ± 26.8 ml, P = 0.33). Total procedural times (61 [56-70] vs 65 [60-75] min, P = 0.12), first-pass PVI (82.6 vs 80%, P = 0.81), acute PV reconnection (0 vs 6.6%, P = 0.05), and 1-year SR maintenance (93.3 vs 90.6%, P = 0.57) rates were also similar in both groups of patients. There were no complications in the combined (90-50 W) group while only 2 groin hematomas were reported in the 50 W group.
Conclusions: In paroxysmal AF patients, a combined (90-50 W) strategy for PVI did not improve safety, efficiency, or effectiveness compared to a 50 W-only AI-guided strategy.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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