A Fluoroless Workflow Using Transoesophageal Echocardiography for Catheter Ablation of Atrial Fibrillation Using Pulsed Field Ablation.

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation Pub Date : 2025-09-04 DOI:10.1016/j.hlc.2025.04.088

Yehuan Zhou, Wee Kian Kenny Tan, Stuart P Thomas, Pierre C Qian

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引用次数: 0

Abstract

Background: Catheter ablations are increasingly performed with zero or minimal fluoroscopy, enabled by ultrasound imaging and electro-anatomical mapping. Pulsed field ablation (PFA) using Farawave has been dependent on fluoroscopic assessment of catheter conformation and contact. We aimed to demonstrate the feasibility of a PFA workflow for pulmonary vein isolation (PVI) and extrapulmonary ablation.

Method: Patients with paroxysmal or persistent atrial fibrillation who underwent fluoroless PVI between August 2023 to October 2024 were included in this study. After transoesophageal echocardiography-guided transeptal puncture, the PentaRay catheter was used to acquire left atrial and pulmonary branch anatomy. The Farawave catheter and Rosen wire, clipped using alligator clips, were visualised using the CARTO 3D Electroanatomical Mapping System (https://www.jnjmedtech.com/en-US/product/carto-3-system). Arrhythmia induction and mapping were routinely performed after PVI to guide further extrapulmonary ablation.

Results: A total of 36 patients were included in this study, with a median age of 60 (52-67) years. All pulmonary veins (PVs) were antrally isolated (130/130 PVs) and 16 patients (44.4%) underwent further extrapulmonary ablations with 13 of 13 successful posterior wall isolations (100%), six of seven linear line ablations achieving bidirectional block (85.7%) and two of two successful superior vena cava isolations (100%). The median total procedure time was 77 (65-93) minutes, left atrial dwelling time of 54 (46-74) minutes, with ablation time of 24 (20-29) minutes.

Conclusions: A fluoroless PFA workflow is feasible and rapid in achieving successful PVI and extrapulmonary ablation to treat atrial fibrillation and induced organised atrial tachyarrhythmias.

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经食管超声心动图对心房颤动导管脉冲场消融的无氟工作流程。

背景：通过超声成像和电解剖成像，越来越多的导管消融在无透视或极少透视的情况下进行。使用farwave的脉冲场消融（PFA）依赖于透视对导管构象和接触的评估。我们的目的是证明PFA工作流程在肺静脉隔离（PVI）和肺外消融中的可行性。方法：在2023年8月至2024年10月期间接受无氟PVI检查的阵发性或持续性房颤患者纳入本研究。经食管超声心动图引导下经间隔穿刺后，使用PentaRay导管获取左心房和肺动脉分支解剖。使用鳄鱼夹夹住farwave导管和Rosen钢丝，使用CARTO 3D电解剖制图系统（https://www.jnjmedtech.com/en-US/product/carto-3-system）进行可视化。在PVI后常规进行心律失常诱导和定位，以指导进一步的肺外消融。结果：本研究共纳入36例患者，中位年龄为60（52-67）岁。所有肺静脉（pv）均经窦分离（130/130 pv）， 16例患者（44.4%）接受了进一步的肺外消融，其中13例后壁分离成功（100%），7例直线消融中6例实现双向阻断（85.7%），2例上腔静脉分离成功（100%）。中位总手术时间为77（65-93）分钟，左房停留时间为54（46-74）分钟，消融时间为24（20-29）分钟。结论：无氟PFA工作流程在实现PVI和肺外消融治疗房颤和诱发的有组织房性心动过速方面是可行和快速的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart, Lung and Circulation CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.50

自引率

3.80%

发文量

912

审稿时长

11.9 weeks

期刊介绍： Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.