| BackgroundIt has been proved that radiofrequency ablation based on circumferential pulmonary vein isolation（CPVI）is a safe and effective strategy for patients with atrial fibrillation（AF）.At present,it is widely used in the clinical treatment of atrial fibrillation and has become the first-line scheme for cardiac rhythm control of atrial fibrillation.As the research continued in-depth in pathogenesis and pathophysiology of atrial fibrillation,ablation equipment and devices improved and operation personnel experiment accumulated,the three popular ablative strategies come into use,inclusive of low power and long duration（LPLD）scheme,high power and short duration（HPSD）scheme and ablation index（AI）guided quantitative ablation scheme 。 Detailed racing into its development history of this technique will be helpful to understand,and further to prevent and control this world-wide distributed disorder.ObjectiveTo explore the safety,efficacy and clinical prediction of LPLD,HPSD and AI guided radiofrequency ablation strategies on atrial fibrillationMethodsThis study involved a cohort of patients with atrial fibrillation who were hospitalized in Puyang Oilfield General Hospital from January 2019 to June 2021 accepting on circumferential pulmonary vein isolation By radiofrequency ablation.The baseline data of patients were collected and compared with each other.According to the time sequence of involvement and the contemporary technology,the patients were chronologically divided into LPLD,HPSD and AI groups respectively.Circumferential pulmonary vein isolation（CPVI）was performed for all the patients involved in the trial by radiofrequency ablation,with posterior wall and top linear ablation added in persistent atrial fibrillation patients extraordinarily.The ablation end point was dual conductance block between pulmonary vein and atrial,and both sides of ablative lines.The ablation parameters were set as follows.LPLD group（N=47）: the ablation power was 35 W,the ablation duration on anterior wall was 30-35 s,the and 25-30 s on posterior wall;the HPSD group（N=43）ablation power was set to 50 W,the ablation duration was 15-20 son anterior wall,and 6-8s on posterior wall,AI group（N=18）was ablated via radiofrequency current guided by AI.The ablation power was set to 45 W,the AI value for anterior wall was 400-450 s,and the posterior wall 330-350 s.The single-loop isolation rate of pulmonary vein,the success rate of bilateral pulmonary vein isolation,total operation time,ablation time,the proportion of postoperative maintenance of sinus rhythm（follow-up in 1,3,6 months）and the incidence of complications were collected and compared among the three groups.ResultsThere was no significant difference statistically in age,gender,hypertension,diabetes mellitus,coronary heart disease,longevity of atrial fibrillation,BNP,LAD,LVEF,type of atrial fibrillation（paroxysmal atrial fibrillation,persistent atrial fibrillation）,CHA2DS2-VASc score and HAS-BLED score among the three groups（P>0.05）.The single-loop isolation rates was in LPLD group（59.6%）,the HPSD group（83.7%）and the AI group（83.3%）were recorded respectively.There was significantly different statistically.The difference in single-loop isolation rate between LPLD group and HPSD group（P < 0.01）was significantly different,whereas not significantly different among other groups（P > 0.05）.The ablation duration of LPLD group（50.67 ±3.96）vs HPSD group（34.95 ±4.19）vs AI（37.89 ±3.94）was significantly different.The right femoral pseudoaneurysm occurred in 2 patients in LPLD group.Whereas high temperature（37.8 ℃）occurred in 1 case in HPSD group with slight pleural effusion in the left chest cavity which was absorbed automatically in 1 month,and 1 patient died of cerebral vascular embolism after ablation.The abovementioned complications were not occurred in AI group.Total operation time,1.3.6-month ablation success rate among different schemes were not significantly different.Conclusion1.The circumferential pulmonary artery isolation by radiofrequency ablation is the safe and effective strategy for cardiac rhythm control in atrial fibrillation;2.The traditional LPLD scheme has the advantage in ablation safety and disadvantage in ablation duration;3.HPSD scheme has the advantages in ablation duration,definite curative effect,safety and reliability.4.AI guided ablation scheme is the improved scheme on the basis of LPLD and HPSD with more advantage and higher success rate.It will be,together with the damage index（DI）,the guidance of optimization and improvement in radiofrequency ablation on atrial fibrillation. |
PDF Full Text Request