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Pulmonary vein isolation using ablation index vs. CLOSE protocol with a surround flow ablation catheter.

使用消融指数的肺静脉隔离与使用环绕流消融导管的密切方案。

  • 影响因子:3.75
  • DOI:10.1093/europace/euz244
  • 作者列表:"Berte B","Hilfiker G","Moccetti F","Schefer T","Weberndörfer V","Cuculi F","Toggweiler S","Ruschitzka F","Kobza R
  • 发表时间:2020-01-01
Abstract

AIMS:Pulmonary vein isolation (PVI) using ablation index (AI) incorporates stability, contact force (CF), time, and power. The CLOSE protocol combines AI and ≤6 mm interlesion distance. Safety concerns are raised about surround flow ablation catheters (STSF). To compare safety and effectiveness of an atrial fibrillation (AF) ablation strategy using AI vs. CLOSE protocol using STSF.,METHODS AND RESULTS:First cluster was treated using AI and second cluster using CLOSE. Procedural data, safety, and recurrence of any atrial tachycardia (AT) or AF >30 s were collected prospectively. All Classes 1c and III anti-arrhythmic drugs (AAD) were stopped after the blanking period. In total, all 215 consecutive patients [AI: 121 (paroxysmal: n = 97), CLOSE: n = 94 (paroxysmal: n = 74)] were included. Pulmonary vein isolation was reached in all in similar procedure duration (CLOSE: 107 ± 25 vs. AI: 102 ± 24 min; P = 0.1) and similar radiofrequency time (CLOSE: 36 ± 11 vs. AI: 37 ± 8 min; P = 0.4) but first pass isolation was higher in CLOSE vs. AI [left veins: 90% vs. 80%; P < 0.05 and right veins: 84% vs. 73%; P < 0.05]. Twelve-month off-AAD freedom of AF/AT was higher in CLOSE vs. AI [79% (paroxysmal: 85%) vs. 64% (paroxysmal: 68%); P < 0.05]. Only four patients (2%) without recurrence were on AAD during follow-up. Major complications were similar (CLOSE: 2.1% vs. AI: 2.5%; P = 0.87).,CONCLUSION:The CLOSE protocol is more effective than a PVI approach solely using AI, especially in paroxysmal AF. In this off-AAD study, 79% of patients were free from AF/AT during 12-month follow-up. The STSF catheter appears to be safe using conventional CLOSE targets.

摘要

目的: 使用消融指数 (AI) 的肺静脉隔离 (PVI) 包括稳定性、接触力 (CF) 、时间和功率。CLOSE 协议结合 AI 和 ≤ 6mm 病变间距离。关于环绕流消融导管 (STSF) 提出了安全问题。比较使用 AI 的房颤 (AF) 消融策略与使用 STSF 的 CLOSE 方案的安全性和有效性。方法和结果: 使用 AI 治疗第一个簇,使用 CLOSE 治疗第二个簇。前瞻性收集任何房性心动过速 (AT) 或 AF >30 s 的手术数据、安全性和复发情况。所有 1c 和 III 类抗心律失常药物 (AAD) 均在消隐期后停用。总共纳入所有 215 例连续患者 [AI: 121 (阵发性: n = 97),CLOSE: n = 94 (阵发性: n = 74)]。在相似的手术持续时间 (CLOSE: 107 ± 25 vs. AI: 102 ± 24 min; P = 0.1) 和相似的射频时间 (接近: 36 ± 11 vs。AI: 37 ± 8 min; P = 0.4) 但第一次通过隔离在 CLOSE vs. AI [左静脉:90% vs. 80%; P <0.05 和右侧静脉: 84% vs. 73%; P <0.05]。12 个月非 AAD AF/AT 的自由度在 CLOSE vs. AI 中较高 [79% (阵发性: 85%) vs. 64% (阵发性: 68%); P <0.05]。随访期间仅 4 例 (2%) 无复发患者接受 AAD 治疗。主要并发症相似 (接近: 2.1% vs. AI: 2.5%; P = 0.87)。,结论: 密合方案比单纯使用 AI 的 PVI 方法更有效,尤其是在阵发性 AF 中。在这项非 AAD 研究中,79% 的患者在 12 个月随访期间无 AF/AT。STSF 导管使用传统的密切靶点似乎是安全的。

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相关文献
影响因子:3.75
发表时间:2020-01-01
DOI:10.1093/europace/euz244
作者列表:["Berte B","Hilfiker G","Moccetti F","Schefer T","Weberndörfer V","Cuculi F","Toggweiler S","Ruschitzka F","Kobza R"]

METHODS:AIMS:Pulmonary vein isolation (PVI) using ablation index (AI) incorporates stability, contact force (CF), time, and power. The CLOSE protocol combines AI and ≤6 mm interlesion distance. Safety concerns are raised about surround flow ablation catheters (STSF). To compare safety and effectiveness of an atrial fibrillation (AF) ablation strategy using AI vs. CLOSE protocol using STSF.,METHODS AND RESULTS:First cluster was treated using AI and second cluster using CLOSE. Procedural data, safety, and recurrence of any atrial tachycardia (AT) or AF >30 s were collected prospectively. All Classes 1c and III anti-arrhythmic drugs (AAD) were stopped after the blanking period. In total, all 215 consecutive patients [AI: 121 (paroxysmal: n = 97), CLOSE: n = 94 (paroxysmal: n = 74)] were included. Pulmonary vein isolation was reached in all in similar procedure duration (CLOSE: 107 ± 25 vs. AI: 102 ± 24 min; P = 0.1) and similar radiofrequency time (CLOSE: 36 ± 11 vs. AI: 37 ± 8 min; P = 0.4) but first pass isolation was higher in CLOSE vs. AI [left veins: 90% vs. 80%; P < 0.05 and right veins: 84% vs. 73%; P < 0.05]. Twelve-month off-AAD freedom of AF/AT was higher in CLOSE vs. AI [79% (paroxysmal: 85%) vs. 64% (paroxysmal: 68%); P < 0.05]. Only four patients (2%) without recurrence were on AAD during follow-up. Major complications were similar (CLOSE: 2.1% vs. AI: 2.5%; P = 0.87).,CONCLUSION:The CLOSE protocol is more effective than a PVI approach solely using AI, especially in paroxysmal AF. In this off-AAD study, 79% of patients were free from AF/AT during 12-month follow-up. The STSF catheter appears to be safe using conventional CLOSE targets.

翻译标题与摘要 下载文献
影响因子:2.45
发表时间:2020-01-01
DOI:10.1111/jce.14268
作者列表:["Qin M","Jiang WF","Wu SH","Xu K","Liu X"]

METHODS:OBJECTIVE:To investigate the role of driver mechanism and the effect of electrogram dispersion-guided driver mapping and ablation in atrial fibrillation (AF) at different stages of progression.,METHODS:A total of 256 consecutive patients with AF who had undergone pulmonary vein isolation (PVI) plus driver ablation or conventional ablation were divided into three groups: paroxysmal atrial fibrillation (PAF; group A, n = 51); persistent atrial fibrillation (PsAF; group B, n = 38); and long standing-persistent atrial fibrillation (LS-PsAF; group C, n = 39). PVI was performed with the guidance of the ablation index. The electrogram dispersion was analyzed for driver mapping.,RESULTS:The most prominent driver regions were at roof (28.0%), posterior wall (17.6%), and bottom (21.3%). From patients with PAF to those with PsAF and LS-PsAF: the complexity of extra-pulmonary vein (PV) drivers including distribution, mean number, and area of dispersion region increased (P < .001). Patients who underwent driver ablation vs conventional ablation had higher procedural AF termination rate (76.6% vs 28.1%; P < .001). With AF progression, the termination rate gradually decreased from group A to group C, and the role of PVI in AF termination was also gradually weakened from group A to group C (39.6%, 7.4%, and 4.3%; P < .001) in patients with driver ablation. At the end of the follow-up, the rate of sinus rhythm maintenance was higher in patients with driver ablation than those with conventional ablation (89.1% vs 70.3%; P < .001).,CONCLUSION:The formation of extra-PV drivers provides an important mechanism for AF maintenance with their complexity increasing with AF progression. Electrogram dispersion-guided driver ablation appears to be an efficient adjunctive approach to PVI for AF treatment.

翻译标题与摘要 下载文献
影响因子:1.65
发表时间:2020-01-06
DOI:10.1007/s10840-019-00700-1
作者列表:["Takamiya T","Nitta J","Inaba O","Sato A","Ikenouchi T","Murata K","Inamura Y","Takahashi Y","Goya M","Hirao K"]

METHODS:PURPOSE:Whether or not pulmonary vein isolation (PVI) plus left atrial posterior wall isolation (PWI) using contact force (CF) sensing improves the ablation outcome for persistent atrial fibrillation (AF) is unclear. This study compared the outcome of PVI plus PWI and additional non-PV trigger ablation for persistent AF with/without CF sensing. METHODS:This retrospective cohort study analyzed 148 propensity score-matched persistent AF patients (median duration of persistent AF, 8 months (interquartile range, 3-24 months); left atrial diameter, 43 ± 7 mm) undergoing PVI plus PWI and ablation of non-PV triggers provoked by high-dose isoproterenol, including 74 with CF-sensing catheters (CF group) and 74 with conventional catheters (non-CF group). PVI plus PWI with no additional ablation but cavotricuspid isthmus ablation was performed without non-PV triggers in 48 CF patients (65%) and 54 non-CF patients (73%) (P = 0.38). In all other patients, we performed additional ablation of provoked non-PV triggers. RESULTS:The Kaplan-Meier estimate of the rate of freedom from atrial tachyarrhythmia recurrence of antiarrhythmic drugs at 12 months after the single procedure was higher in the CF group than in the non-CF group (85 vs. 70%, log-rank P = 0.030). A multivariable analysis revealed that using CF sensing and non-inducibility of AF from a non-PV trigger after PVI and PWI were significantly associated with a reduced rate of atrial tachyarrhythmia recurrence. CONCLUSIONS:Compared with non-CF sensing, PVI plus PWI and additional non-PV trigger ablation using CF-sensing catheters for persistent AF can reduce the rate of atrial tachyarrhythmia recurrence.

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