零透视脉冲场消融治疗心房颤动的学习曲线和程序效率。

IF 5.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Juliana Pérez-Pinzón, Daniel Villarreal, Mengyu Ma, John-Ross Clarke, Enrico G Ferro, Ronuk Modi, Omeralfaroug Adam, Nicolas Isaza, Gabriel Odozynski, Gursharan Samra, Margot Yopes, Eduardo B Saad, Peter Zimetbaum, Charles I Haffajee, Shu Yang, Timothy Maher, Kapil Kumar, Alexei Shvilkin, Andre d'Avila, Gregory F Michaud, Patricia Tung, Jonathan W Waks, Andrew H Locke
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引用次数: 0

摘要

背景:与射频消融(RFA)相比,脉冲场消融(PFA)治疗心房颤动(AF)已经证明了安全性和非劣效性。然而,使用零透视工作流程比较RFA和PFA的实际数据,特别是关于急性手术效率和结果的数据仍然有限。目的:比较某大型学术机构无透视RFA和PFA PVI的手术特点。方法:我们分析了2022年1月至2025年3月期间827例连续的零透视首次消融。仅包括PVI或PVI合并后壁隔离(PWI)病变组的患者。手术时间定义为静脉进入鞘鞘取出时间。采用混合效应回归模型进行统计分析。结果:平均年龄为65±10岁,68%的患者为男性,54%的患者为阵发性房颤。无透视RFA和PFA手术分别比透视引导下的手术短25分钟和14分钟(结论:无透视PFA是安全有效的,与无透视RFA相比,急性手术结果和安全性相当。零透视PFA学习曲线与职业阶段或医师无关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Learning Curve and Procedural Efficiency of Zero-Fluoroscopy Pulsed-Field Ablation for Atrial Fibrillation.

Background: Pulsed-field ablation (PFA) has demonstrated safety and non-inferiority compared to radiofrequency ablation (RFA) for atrial fibrillation (AF). However, real-world data comparing RFA and PFA using a zero-fluoroscopy workflow, particularly regarding acute procedural efficiency and outcomes, remains limited.

Objective: To compare procedural characteristics of zero-fluoroscopy RFA and PFA PVI at a high-volume academic institution.

Methods: We analyzed 827 consecutive zero-fluoroscopy first-time ablations performed between January 2022 and March 2025. Only patients with PVI or PVI with posterior wall isolation (PWI) lesion sets were included. Procedure time was defined as venous access to sheath removal time. Mixed-effects regression models were used for statistical analysis.

Results: Mean age was 65±10 years, 68% of patients were male, and 54% had paroxysmal AF. Zero-fluoroscopy RFA and PFA procedures were 25 and 14 minutes shorter, respectively, than fluoroscopy-guided procedures (p<0.001). Zero-fluoroscopy procedure time was significantly reduced with PFA compared to RFA (-25 minutes), particularly during PVI+PWI (PVI: -16 minutes; PVI+PWI: -28 minutes) (p<0.001). The learning curve for zero-fluoroscopy PFA did not vary by physician or years of experience and plateaued after 114 total PFA cases. Based on the mixed-effects model analysis, each additional PFA case performed reduced procedure time by 0.5 minutes (p<0.001). Severe complications were rare (0.48%), with no significant difference between energy types.

Conclusions: Zero-fluoroscopy PFA is safe and effective, with comparable acute procedural outcomes and safety profile compared to zero-fluoroscopy RFA. Zero-fluoroscopy PFA learning curve is independent of career stage or physician.

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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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