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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Transmural unipolar electrogram change occurs within 7?s at the left atrial posterior wall during pulmonary vein isolation
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Transmural unipolar electrogram change occurs within 7?s at the left atrial posterior wall during pulmonary vein isolation

机译：在肺静脉隔离期间，在左心房后壁的7℃内发生透射单极电子图变化

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Abstract Background To assess occurrence of a histologically validated measure of transmural (TM) atrial ablation—pure R unipolar electrogram (UE) morphology change—at first‐ablated left atrial posterior wall (LAPW) sites during contact force (CF)‐guided pulmonary vein isolation (PVI). Methods Objectively annotated VISITAG? Module and CARTOREPLAY? (Biosense Webster Inc., Diamond Bar, CA, USA) UE morphology data were retrospectively analyzed in 23 consecutive patients undergoing PVI under general anesthesia. Results PVI without spontaneous/dormant recovery was achieved in all, employing 16.3 (3.2) min of radiofrequency (RF; 30?W) energy. All first‐ablated LAPW sites demonstrated RS UE morphology preablation, with RF‐induced pure R UE morphology change in 98%. Time to pure R UE morphology was significantly shorter at left‐sided LAPW sites (4.9 [2.1] vs 6.7 [2.5] s; P ?=?.02), with significantly greater impedance drop (median 13.5?vs 9.9?Ω; P ?=?.003). Importantly, neither first‐site RF duration (14.9 vs 15.0?s) nor maximum ablation catheter tip distance moved (during RF) was significantly different, yet the mean CF was significantly higher at right‐sided sites (16.5?vs 11.2?g; P ?=?.002). Concurrent impedance and objectively annotated bipolar electrogram (BE) data demonstrated ～6‐8?Ω impedance drop and ～30% BE decrease at the time of first pure R UE morphology change. Conclusions Using objective ablation site annotation, UE morphology evidence of TM RF effect was demonstrated far sooner than considered biologically possible according to the “conventional” 20‐40?s RF per‐site approach, with significantly greater ablative effect evident at left‐sided sites. This novel methodology represents a scientifically more rigorous foundation toward future research into the biological effects of RF ablation in vivo.
机译：摘要背景，用于评估接触力（CF）导向肺静脉的第一烧蚀左心房后壁（UE）形态变化 - 在第一烧蚀左心房后壁（LAPW）位点的组织学验证度量的发生隔离（PVI）。方法客观注释的访问吗？模块和型画？ （BioSense Webster Inc.，Diamond Bar，CA，USA）在一般麻醉下进行了23例PVI的连续患者中回顾性地分析了UE形态数据。结果在没有自发/休眠回收的情况下，所有的PVI都实现了16.3（3.2）分钟的射频（RF; 30？W）能量。所有第一消融的LAPW网站都表现出RS UE形态的序列，RF诱导纯r ue形态发生在98％。左侧LAPW网站（4.9 [2.1] vs 6.7 [2.5] S; p？= 02），纯r ue形态的时间显着缩短，具有显着更大的阻抗下降（中位数13.5？与9.9？ω; p; p ？=？003）。重要的是，在右侧位点（RF期间，在RF）中没有最大位点的RF持续时间（14.9 Vs 15.0〜S）也不是最大消融导管尖端距离，但右侧位点（16.5Ωvs11.2≤g; p？= 002）。并发阻抗和客观的注释双极电子图（BE）数据显示〜6-8Ω·Ω阻抗下降，在第一纯R UE形态变化时〜30％减少。结论采用客观消融部位注释，根据“常规”20-40次射频的射频方法，SEE形态证据表明TM射频效应的效果较早得多，据考虑了生物学，在左侧场地具有明显更大的嗜肥效应。这种新颖的方法论为未来研究进入体内RF消融的生物学作用的科学更严格的基础。

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