Optimal Force-Time Integral for Pulmonary Vein Isolation According to Anatomical Wall Thickness Under the Ablation Line

被引:34
作者
Chikata, Akio [1 ,2 ]
Kato, Takeshi [1 ]
Sakagami, Satoru [2 ]
Kato, Chieko [2 ]
Saeki, Takahiro [2 ]
Kawai, Keiichi [3 ]
Takashima, Shin-ichiro [1 ]
Murai, Hisayoshi [1 ]
Usui, Soichiro [1 ]
Furusho, Hiroshi [1 ]
Kaneko, Shuichi [1 ]
Takamura, Masayuki [1 ]
机构
[1] Kanazawa Univ, Grad Sch Med Sci, Dept Dis Control & Homeostasis, 13-1 Takara Machi, Kanazawa, Ishikawa 9208641, Japan
[2] Natl Hosp Org, Kanazawa Med Ctr, Dept Cardiol, Kanazawa, Ishikawa, Japan
[3] Natl Hosp Org, Kanazawa Med Ctr, Dept Radiol, Kanazawa, Ishikawa, Japan
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2016年 / 5卷 / 03期
关键词
atrial fibrillation; atrial wall thickness; contact force; force-time integral; pulmonary vein isolation; RADIOFREQUENCY LESION SIZE; LEFT ATRIAL ANATOMY; CONTACT FORCE; CATHETER ABLATION; FIBRILLATION; MODEL;
D O I
10.1161/JAHA.115.003155
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Low contact force and force-time integral (FTI) during catheter ablation are associated with ineffective lesion formation, whereas excessively high contact force and FTI may increase the risk of complications. We sought to evaluate the optimal FTI for pulmonary vein (PV) isolation based on atrial wall thickness under the ablation line. Methods and Results-Contact force parameters and FTI during anatomical ipsilateral PV isolation for atrial fibrillation and atrial wall thickness were assessed retrospectively in 59 consecutive patients for their first PV isolation procedure. The PV antrum was divided into 8 segments, and the wall thickness of each segment under the ablation line was determined using multidetector computed tomography. The FTI for each ablation point was divided by the wall thickness of the PV antrum segment where each point was located to obtain FTI/wall thickness. In total, 5335 radiofrequency applications were delivered, and 85 gaps in PV isolation ablation lines and 15 dormant conductions induced by adenosine were detected. The gaps or dormant conductions were significantly associated with low contact force, radiofrequency duration, FTI, and FTI/wall thickness. Among them, FTI/wall thickness had the best prediction value for gaps or dormant conductions by receiver operating characteristic curve analysis. FTI/wall thickness of < 76.4 gram-seconds per millimeter (gs/mm) predicted gaps or dormant conductions with sensitivity (88.0%) and specificity (83.6%), and FTI/wall thickness of < 101.1 gs/mm was highly predictive (sensitivity 97.0%; specificity 69.6%). Conclusions-FTI/wall thickness is a strong predictor of gap and dormant conduction formation in PV isolation. An FTI/wall thickness approximate to 100 gs/mm could be a suitable target for effective ablation.
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页数:7
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