A Study On The Efficacy And Safety Of VisiTag In The Catheter Ablation Of Paroxysmal Atrial Fibrillation

Background: Atrial fibrillation is one of the common arrhythmias in clinical practice.Anti-arrhythmia drugs have poor efficacy in controlling rhythm of atrial fibrillation,repeated attacks,long treatment cycle,and large side effects of drugs,which increase the economic and psychological burden of patients.In recent years,radiofrequency ablation has developed rapidly in the treatment of atrial fibrillation,and has gradually become a first-line program for paroxysmal atrial fibrillation control.Although the radiofrequency ablation technology has been quite mature,the recurrence rate after ablation of atrial fibrillation is still high,and patients with recurrence need to repeat the operation.Although immediate isolation of potential between the pulmonary veins and the atrium can be achieved during radiofrequency ablation of atrial fibrillation,late recovery of electrical conduction may occur,which is the main cause of recurrence of atrial fibrillation.To achieve a low recurrence rate after radiofrequency ablation of atrial fibrillation,the key lies in the formation of continuous and transmural myocardial injury during ablation,and the realization of anatomical and electrical isolation between pulmonary veins and atrium.In order to form continuous and transmural myocardial injury,sufficient ablation catheter pressure,ablation time and other factors are required,so as to ensure the stability of catheter abutment,so that the energy of the ablation catheter can be continuously and stably delivered to the myocardial cells and achieve effective ablation.Visitag system can provide real-time ablation parameters(ablation pressure,time,power,etc.),and can mark ablation points with different colors,providing an objective basis for surgeons to judge the stability of catheter,so as to achieve precise ablation and reduce postoperative recurrence rate.Objective: To evaluate the clinical efficacy of Visitag guided radiofrequency ablation for paroxysmal atrial fibrillation(AF).Methods: 100 patients with paroxysmal atrial fibrillation who were hospitalized in department of cardiology,yijishan hospital of wannan medical college during August 2015 to August 2017 and underwent radiofrequency circumpulmonary vein ablation were randomly selected,including 50 patients who used VisiTag software to guide ablation,and were defined as research group.The other 50 patients using the traditional ablation strategy were defined as the control group,these patients undergoing paroxysmal atrial fibrillation without VisiTag guidance.Selected 100 cases of the patients with paroxysmal atrial fibrillation,have been in the preoperative surgical contraindications,both in the measuring system with electrical dissection(CARTO3)downlink left atrial and pulmonary vein anatomy modeling,line ring pulmonary vein isolation technique to incoming and outgoing bipolar between pulmonary vein and atrial electrical isolation,intraoperative use of Johnson &johnson production Smart Touch pressure induction cold saline infusion catheter.Results of ablation time(min),X-ray fluoroscopy time(min),single circle isolation rate,number of points outside the ablation diameter line(n),and surgical complications were compared between the two groups postoperatively,followed up for 1 year,and the recurrence rate after the ablation was compared between the two groups for 1 year.Results: Compared with the control group,the ablation discharge time(45.01±3.07 vs.54.16±2.90 min,P<0.05)in the study group was significantly reduced,but the X-ray fluoroscopy time(3.25±0.23 vs.3.77±0.33 min,P>0.05)was not significantly different.Ablation lap isolation rate(96% vs.80%,P < 0.05)significantly improve,ablation lines always fill points(15 vs 131)significantly reduced,surgery related complications(pericardial tamponade: 0/50 vs 1/50,P > 0.05)incidence is low,followed up for 1 year,the team success rate of atrial fibrillation after 1 year is significantly higher than control group(88% vs.70%,P < 0.05).Conclusion: For patients with paroxysmal atrial fibrillation,only by ensuring the catheter pressure,ablation time and the stability of catheter to tissue adhesion during ablation can the leakage point of ablation be reduced to the greatest extent,achieving continuous ablation damage through the wall,reducing postoperative potential reconnection between pulmonary venous and atrium,and reducing the postoperative recurrence rate of atrial fibrillation.Visitag can be used to guide the circumferential pulmonary vein isolation surgery,so that the intraoperative ablation parameters can be clarified.Strict preoperative parameter setting can provide an objective stability marker,which can improve the ablation efficiency and reduce the recurrence of atrial fibrillation compared with the subjective selection of the operator.