经皮穿刺位置在卵圆窝对首次肺静脉分离的影响

Kohei Matsunaga, Tadashi Hoshiyama, Shozo Kaneko, Hitoshi Sumi, Hisanori Kanazawa, Yuta Tsurusaki, Yuichiro Tsuruta, Masanobu Ishii, Shinsuke Hanatani, Hiroki Usuku, Eiichiro Yamamoto, Yasuhiro Izumiya, Kenichi Tsujita
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Therefore, we investigate the relationship through this investigation.\nMethods: Overall, 102 consecutive patients who had undergone their first RFCA for AF were included. These patients were divided based on the transseptal puncture location (infero-anterior, infero-posterior, supero-anterior, and supero-posterior), which was confirmed by imaging of three-dimensional structure of the anatomical fossa ovalis creating intracardiac echocardiography. The relationship between transseptal puncture location and the first-pass PV isolation success rate was analyzed.\nResults: Among all 102 patients, the number of transseptal puncture locations located in infero-anterior, infero-posterior, supero-anterior, and supero-posterior were 26, 61, 6, and 9 respectively. 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摘要

背景:近来,射频导管消融术(RFCA)已成为心房颤动(房颤)的重要治疗策略。在这一过程中,实现首过肺静脉(PV)隔离--即在 PV 周围形成初始环向病变后不残留传导间隙的 PV 隔离--已被证明能在房颤复发方面带来更好的效果。虽然已经提出了产生残余传导间隙的各种风险因素,但卵圆窝上的经静脉穿刺位置与首次PV隔离成功率之间的关系尚未明确。因此,我们通过此次调查研究两者之间的关系:方法:共纳入 102 例连续接受首次房颤 RFCA 的患者。这些患者根据经皮穿刺位置(前下、后下、前上、后上)进行分类,并通过心内超声心动图对解剖学上的卵圆窝三维结构进行成像确认。分析了经皮穿刺位置与首次分离上腔静脉成功率之间的关系:结果:在所有 102 例患者中,经静脉穿刺位置位于前方下段、后方下段、前方上段和后方上段的患者分别为 26 例、61 例、6 例和 9 例。其中,与其他位置[下前 61%(16/26 例患者)、上前 33%(2/6 例患者)和上后 44%(4/9 例患者);P=0.02]相比,下后组的首次 PV 隔离成功率最高,达 79%(48/61 例患者)。在消融参数方面,虽然各组之间的消融指数无明显差异(前下401.6±7.6,后下401.9±5.2,前上397.5±4.7,后上398.6±5.3,P=0.176)。P-矢量代表导管接触不足,在后下方组(8.6%;P <;0.01)观察到的P-矢量频率明显低于其他组:结论:PV 隔离中的经皮穿刺位置是实现首次 PV 隔离的重要因素,可能会影响房颤复发。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of transseptal puncture location on the fossa ovalis on first-pass pulmonary vein isolation
Background: Recently, radiofrequency catheter ablation (RFCA) has become an important treatment strategy for atrial fibrillation (AF). During this procedure, achieving first-pass pulmonary vein (PV) isolation — PV isolation in which no residual conduction gap remains following initial circumferential lesion is created around the PV — has proven to lead better results in terms of AF recurrence. Although various risk factors for the creation of residual conduction gap have been proposed, the relationship between the transseptal puncture location on fossa ovalis and first-pass PV isolation success rate has not been clarified. Therefore, we investigate the relationship through this investigation. Methods: Overall, 102 consecutive patients who had undergone their first RFCA for AF were included. These patients were divided based on the transseptal puncture location (infero-anterior, infero-posterior, supero-anterior, and supero-posterior), which was confirmed by imaging of three-dimensional structure of the anatomical fossa ovalis creating intracardiac echocardiography. The relationship between transseptal puncture location and the first-pass PV isolation success rate was analyzed. Results: Among all 102 patients, the number of transseptal puncture locations located in infero-anterior, infero-posterior, supero-anterior, and supero-posterior were 26, 61, 6, and 9 respectively. Among these, first-pass PV isolation success rate in the infero-posterior group exhibited the highest 79% (48/61 patients) compared to that in other locations [infero-anterior 61% (16/26 patients), supero-anterior 33% (2/6 patients), and supero-posterior 44% (4/9 patients); P=0.02]. Regarding ablation parameters, although the ablation index was not significantly different between each group (infero-anterior 401.6±7.6, infero-posterior 401.9±5.2, supero-anterior 397.5±4.7, and supero-posterior 398.6±5.3, P = 0.176). The P-vector, which represents insufficient catheter contact, was significantly observed lower frequency in the infero-posterior group (8.6%; P < 0.01) than in the other groups. Conclusion: The transseptal puncture location in PV isolation is an important factor to achieve first-pass PV isolation, and it might affect AF recurrence.
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