| Background:Circumferential pulmonary vein isolation(CPVI)has become the basic procedure for catheter ablation in patients with atrial fibrillation(AF),especially paroxysmal AF(PAF),but there is no unified standardized procedure.Therefore,"FA2D5"ablation mode is proposed for the first time in this study based on the following four aspects:modeling method,ablation site,ablation lesion depth and contiguity,of which "F"represents Fast anatomic modeling(FAM),"A2" represents pulmonary vein Antrum and Ablation index(AI),"D5" represents neighbouring lesions Distance?5mm,and it is expected to become a standardized procedure of pulmonary vein isolation.Objective:To observe the short-term efficacy and safety of radiofrequency catheter ablation(RFCA)with "FA2D5" ablation mode used in PAF patients and analyze the risk factors of AF recurrence after "FA2D5" ablation mode.Method:97 patients with paroxysmal atrial fibrillation who were to undergo RFC A in our hospital from June 2018 to September 2019 were enrolled in this study.All of patients were performed CPVI with "FA2D5" ablation mode.Ablation site was set up at pulmonary vein antrum 0.5-1.0 cm from the pulmonary vein ostia.According to 9-segment of PV,the AI values of the posterior wall,the inferior wall,the anterior wall,the roof and the ridge were 300-380u,350-400u,400-450u,350-400u and 400-450u respectively.Patients were followed up regularly by outpatient or telephone after discharge.Atrial fibrillation recurrence was defined as any documented atrial tachyarrhythmia(AF,atrial flutter,or atrial tachycardia)lasting?30s by ECGs or Holters after the post-ablation 3-month blanking period and was recorded as an endpoint event.Kaplan-Meier survival curve was used to analyze the success rate of "FA2D5" ablation mode in patients with AF,and logistic multiple regression was used to analyze the risk factors of AF recurrence.Results:1)Patients had a mean age of 60.8±10.29 years;43.3%of them were female.Median AF duration was 6 months.The mean CHA2DS2-VASc score was 1.7±1.24.The mean LA diameter was 41.9±5.06 mm and the mean LVEF was 63.1±6.21%.Anticoagulation rate was 99.0%before ablation.2)The mean operation time of "FA2D5"ablation mode was 104±17.5 min;the mean X-ray exposure time of was 5.8±2.7 min;the mean time before modeling was 31±7.5 min;the mean FAM modeling time was 9.7±2.8 min;the mean ablation time of LPVs and RPVs was 33±7.2 min and 31±8.1 min respectively.3)The total success rate of PVs single circle isolation guided by "FA2D5"ablation mode was 93.8%,while the single circle isolation rate of LPVs and RPVs was 92.8%and 94.5%respectively.4)After a median 9-months follow-up(range 7 to 13 months),freedom from AF recurrence was 89.2%overall.There were no serious complications such as pericardial tamponade,cerebral embolism,pulmonary vein stenosis and atrioesophageal fistula.5)The proportion of patients sufferring from structural heart disease in patients with AF recurrence was higher compared with the patients without AF recurrence.Multivariate logistic regression analysis indicated that structural heart disease was an independent risk factor for AF recurrence in patients after ablation guided by"FA2D5" ablation mode.6)There was no statistical difference of AI values at each pulmonary vein segment between the patients with and without AF recurrence,but the patients with AF recurrence had at least one pulmonary vein segment with increased AI dispersion and/or lack of target AI main column which was greater than 35%.Conclusion:It is feasible and safe for patients with paroxysmal AF to catheter ablate according to "FA2D5" ablation mode;"FA2D5”ablation mode can improve the ablation efficiency,PVs single circle isolation rate and short-term success rate;structural heart disease is the risk factor for AF recurrence after ablation guided by "FA2D5" ablation mode;increased AI dispersion of pulmonary vein segments and/or lack of target AI main column greater than 35%were associated with AF recurrence using "FA2D5" ablation mode in paroxysmal AF patients. |
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