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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Atrial fibrillation ablation using a closed irrigation radiofrequency ablation catheter
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Atrial fibrillation ablation using a closed irrigation radiofrequency ablation catheter

机译：使用封闭式冲洗射频消融导管进行房颤消融

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Background: Catheter ablation is an effective therapy for symptomatic, medically refractory atrial fibrillation (AF). Open-irrigated radiofrequency (RF) ablation catheters produce transmural lesions at the cost of increased fluid delivery. In vivo models suggest closed-irrigated RF catheters create equivalent lesions, but clinical outcomes are limited. Methods: A cohort of 195 sequential patients with symptomatic AF underwent stepwise AF ablation (AFA) using a closed-irrigation ablation catheter. Recurrence of AF was monitored and outcomes were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards models. Results: Mean age was 59.0 years, 74.9% were male, 56.4% of patients were paroxysmal and mean duration of AF was 5.4 years. Patients had multiple comorbidities including hypertension (76.4%), tobacco abuse (42.1%), diabetes (17.4%), and obesity (mean body mass index 30.8). The median follow-up was 55.8 weeks. Overall event-free survival was 73.6% with one ablation and 77.4% after reablation (reablation rate was 8.7%). Median time to recurrence was 26.9 weeks. AF was more likely to recur in patients being treated with antiarrhythmic therapy at the time of last follow-up (recurrence rate 30.3% with antiarrhythmic drugs, 13.2% without antiarrhythmic drugs; hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.1-4.4, P = 0.024) and in those with a history of AF greater than 2 years duration (HR 2.7, 95% CI 1.1-6.9, P = 0.038). Conclusions: Our study represents the largest cohort of patients receiving AFA with closed-irrigation ablation catheters. We demonstrate comparable outcomes to those previously reported in studies of open-irrigation ablation catheters. Given the theoretical benefits of a closed-irrigation system, a large head-to-head comparison using this catheter is warranted. (PACE 2012; 35:506-513)
机译：背景：导管消融术是对症性，难治性房颤的一种有效疗法。开放式射频消融导管会产生透壁病变，但输液量增加。体内模型表明，封闭灌溉的RF导管可产生同等的病变，但临床结果有限。方法：队列研究的195例有症状的房颤患者采用封闭冲洗消融导管进行逐步房颤消融（AFA）。监测房颤的复发，并使用Kaplan-Meier生存分析和Cox比例风险模型评估结局。结果：平均年龄为59.0岁，男性为74.9％，阵发性为56.4％，房颤的平均持续时间为5.4年。患者患有多种合并症，包括高血压（76.4％），吸烟（42.1％），糖尿病（17.4％）和肥胖（平均体重指数30.8）。中位随访时间为55.8周。一次消融的总体无事件生存率为73.6％，消融后的无事件生存率为77.4％（消融率为8.7％）。复发的中位时间为26.9周。在最后一次随访时，接受抗心律失常治疗的患者更容易发生房颤（抗心律失常药物的复发率为30.3％，无抗心律失常药物的复发率为13.2％;危险比[HR] 2.2，95％置信区间[CI] 1.1-4.4，P = 0.024），以及有2年以上房颤史的患者（HR 2.7，95％CI 1.1-6.9，P = 0.038）。结论：我们的研究代表了使用封闭冲洗消融导管接受AFA的最大患者群。我们证明了与开放灌溉消融导管研究中先前报道的结果相当的结果。考虑到封闭灌溉系统的理论优势，使用这种导管进行大规模的头对头比较是有必要的。 （PACE 2012; 35：506-513）

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