使用焦点导管在心室流出道进行脉冲场消融的可行性和安全性

IF 5.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Lihui Zheng, Pakezhati Maimaitijiang, Aiyue Chen, Zihao Lai, Yan Yao
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引用次数: 0

摘要

背景:室性心律失常通常起源于心室流出道(VOT)。脉冲场消融术(PFA)能否安全地在室性心律失常流出道(VOT)形成持久的病灶仍是一个未知数:本研究旨在评估新型 PFA 导管对 VOT(尤其是肺动脉窦和主动脉窦)进行病灶消融的可行性和安全性:方法:12 头猪分为三组:消融后 24 小时组、消融后 2 周组和消融后 4 周组。通过绘图系统、透视和心内超声心动图(ICE)定位,使用焦点导管将 PFA 输送到 PSC 和 ASC 的预定位点。此外,还进行了电生理评估、冠状动脉造影、经食道超声心动图(TEE)、大体和组织学检查,以评估PFA输送对心脏结构和功能的影响:结果:所有受试者均存活,未发现不良反应。PSCs 和 ASCs 的电压振幅明显下降,起搏阈值上升。消融前后的 A-H 或 H-V 间期无明显差异(A-H,P = .70;H-V,P = .90)。向 ASCs 输送 PFA 后,每颗心脏的冠状动脉都得到了充分灌注,没有观察到 ST 段抬高。根据 ICE 和 TEE 观察,没有发现严重的瓣膜功能障碍。大体和组织学检查证实,目标部位的病变界限清晰,没有损伤邻近结构:结论:通过病灶导管输送的 PFA 可在 PSC 和 ASC 形成持久病变,不会损伤冠状动脉、房室传导阻滞或瓣膜功能障碍,这表明这种新型 PFA 导管在 VOT 的可行性和安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Feasibility and safety of pulsed field ablation at the ventricular outflow tract using focal point catheter.

Background: Ventricular arrhythmias commonly originate from the ventricular outflow tract. It remains unexplored whether pulsed field ablation (PFA) can create durable lesions safely at the ventricular outflow tract.

Objective: This study aimed to evaluate the feasibility and safety of a novel PFA catheter to deliver focal ablation to the ventricular outflow tract, especially pulmonary and aortic sinus cusps (PSCs and ASCs).

Methods: Twelve swine were divided into 3 groups: 24-hour, 2-week, and 4-week post-ablation. PFA was delivered to predefined sites of PSCs and ASCs with a focal point catheter, positioned by a mapping system, fluoroscopy, and intracardiac echocardiography. Electrophysiologic assessment, coronary angiography, transesophageal echocardiography, and gross and histologic examination were performed to evaluate the impact of PFA delivery on cardiac structure and function.

Results: All subjects survived, and no adverse events were observed. There was a significant decrease in voltage amplitude and increase in pacing thresholds at PSCs and ASCs. There were no significant differences in AH or HV intervals between pre-ablation and post-ablation (AH, P = .70; HV, P = .90). After PFA delivery to ASCs, coronary arteries were fully perfused in each heart, without ST-segment elevation observed. No severe valvular dysfunction was observed on intracardiac echocardiography and transesophageal echocardiography. Gross and histologic examination confirmed the creation of well-demarcated lesions at the targeted sites without damage to adjacent structures.

Conclusion: PFA delivered by the focal point catheter could create durable lesions at PSCs and ASCs without damage to coronary arteries, atrioventricular block, or valvular dysfunction, indicative of the feasibility and safety of this novel PFA catheter at the ventricular outflow tract.

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来源期刊
Heart rhythm
Heart rhythm 医学-心血管系统
CiteScore
10.50
自引率
5.50%
发文量
1465
审稿时长
24 days
期刊介绍: HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.
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