Voltage-Guided and Non-Voltage-Guided Superior Vena Cava Isolation in Patients With Atrial Fibrillation.

IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pace-Pacing and Clinical Electrophysiology Pub Date : 2024-10-22 DOI:10.1111/pace.15093
Jumpei Saito, Kato Daiki, Sato Hirotoshi, Toshihiko Matsuda, Yui Koyanagi, Katsuya Yoshihiro, Yuma Gibo, Ishigaki Shigehiro, Soichiro Usumoto, Wataru Igawa, Toshitaka Okabe, Naoei Isomura, Masahiko Ochiai
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引用次数: 0

Abstract

Background: In addition to the pulmonary vein, the superior vena cava (SVC) is an important focus of atrial fibrillation (AF). However, SVC isolation may cause serious complications, and appropriate settings and techniques for SVC isolation are lacking.

Methods: This study enrolled 86 consecutive patients with AF who underwent SVC isolation. Voltage mapping using a multi-electrode catheter and ablation were performed under the guidance of an electro-anatomical mapping system. The lines encircling the SVC were divided into eight anatomic segments on the SVC geometry, and each segment was subjected to voltage-guided (VG) ablation in decreasing order of voltage (starting from the segment with the highest voltage). Non-VG (NVG) ablation was performed anatomically from the anterior wall toward the septum with one-round cautery.

Results: A total of 86 cases (66 males, mean age 69 [60, 74], mean CHA2DS2 VASc score 2 [1, 3], 58 paroxysmal AF) with AF were included for ablation. Electrical SVC isolation was successfully achieved in all patients. The length of the myocardial sleeves, as measured from the SVC-RA junction to the end of the local signal, was 37 [28, 45] mm. Major axis of the RA-SVC junction was 15 [13, 17] and minor axis of the RA-SVC junction was 11 [9, 13]. The number of ablation points with VG SVC isolation was fewer than that for NVG SVC isolation (8 [5, 11.5] vs. 11.5 [8.8, 13.3]; p = 0.001). The procedure time of VG SVC isolation was greater than that of NVG SVC isolation (259 s [154, 379] vs. 167 s [115, 222]; p = 0.012). There were no significant differences in the complication rates.

Conclusions: VG SVC isolation reduced the number of ablation points compared with NVG SVC isolation.

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心房颤动患者的电压引导和非电压引导上腔静脉隔离。
背景:除肺静脉外,上腔静脉(SVC)也是心房颤动(AF)的重要病灶。然而,上腔静脉隔离可能会引起严重的并发症,目前还缺乏上腔静脉隔离的适当设置和技术:本研究连续收治了86名接受SVC隔绝术的房颤患者。在电子解剖图系统的指导下,使用多电极导管绘制电压图并进行消融。根据 SVC 的几何形状,将环绕 SVC 的线分为八个解剖区段,每个区段按电压递减顺序(从电压最高的区段开始)进行电压引导(VG)消融。非电压引导(NVG)消融是从前壁向室间隔方向用一圈烧灼法进行解剖消融:共有 86 例房颤患者(66 例男性,平均年龄 69 [60, 74] 岁,平均 CHA2DS2 VASc 评分 2 [1, 3] 分,阵发性房颤 58 例)接受了消融术。所有患者均成功实现了 SVC 电隔离。从 SVC-RA 交界处到局部信号末端测量的心肌袖长为 37 [28, 45] mm。RA-SVC 交界处的主要轴线为 15 [13, 17],RA-SVC 交界处的次要轴线为 11 [9, 13]。VG SVC 切除术的消融点数少于 NVG SVC 切除术(8 [5, 11.5] vs. 11.5 [8.8, 13.3]; p = 0.001)。VG SVC隔绝术的手术时间长于 NVG SVC隔绝术(259 秒 [154, 379] vs. 167 秒 [115, 222]; p = 0.012)。并发症发生率无明显差异:结论:与NVG SVC隔绝术相比,VG SVC隔绝术减少了消融点的数量。
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来源期刊
Pace-Pacing and Clinical Electrophysiology
Pace-Pacing and Clinical Electrophysiology 医学-工程:生物医学
CiteScore
2.70
自引率
5.60%
发文量
209
审稿时长
2-4 weeks
期刊介绍: Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.
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