医学
烧蚀
心房颤动
肺静脉
导管消融
透视
导管
经皮
心脏病学
外科
内科学
作者
Vivek Y. Reddy,Jacob S. Koruth,Pierre Jaı̈s,Jan Petrů,Ferdinand Timko,Ivo Skalský,Robert F. Hebeler,Louis Labrousse,Laurent Barandon,Štěpán Královec,Moritoshi Funosako,Boochi Babu Mannuva,Lucie Šedivá,Petr Neužil
标识
DOI:10.1016/j.jacep.2018.04.005
摘要
The authors report the first acute clinical experience of atrial fibrillation ablation with PEF-both epicardial box lesions during cardiac surgery, and catheter-based PV isolation.Standard energy sources rely on time-dependent conductive heating/cooling and ablate all tissue types indiscriminately. Pulsed electric field (PEF) energy ablates nonthermally by creating nanoscale pores in cell membranes. Potential advantages for atrial fibrillation ablation include: 1) cardiomyocytes have among the lowest sensitivity of any tissue to PEF-allowing tissue selectivity, thereby minimizing ablation of nontarget collateral tissue; 2) PEF is delivered rapidly over a few seconds; and 3) the absence of coagulative necrosis obviates the risk of pulmonary vein (PV) stenosis.PEF ablation was performed using a custom over-the-wire endocardial catheter for percutaneous transseptal PV isolation, and a linear catheter for encircling the PVs and posterior left atrium during concomitant cardiac surgery. Endocardial voltage maps were created pre- and post-ablation. Continuous and categorical data are summarized and presented as mean ± SD and frequencies.At 2 centers, 22 patients underwent ablation under general anesthesia: 15 endocardial and 7 epicardial. Catheter PV isolation was successful in all 57 PVs in 15 patients (100%) using 3.26 ± 0.5 lesions/PV: procedure time 67 ± 10.5 min, catheter time (PEF catheter entry to exit) 19 ± 2.5 min, total PEF energy delivery time <60 s/patient, and fluoroscopy time 12 ± 4.0 min. Surgical box lesions were successful in 6 of 7 patients (86%) using 2 lesions/patient. The catheter time for epicardial ablation was 50.7 ± 19.5 min. There were no complications.These data usher in a new era of tissue-specific, ultrarapid ablation of atrial fibrillation.
科研通智能强力驱动
Strongly Powered by AbleSci AI