Efficacy and safety of high-power short-duration on the modified box isolation for persistent atrial fibrillation

doi:10.3969/j.issn.1004-583X.2024.10.008

Abstract

Abstract:

Objective To evaluate the efficacy and safety of high-power short-duration (HPSD) on the modified box isolation (BOXI) for persistent atrial fibrillation (AF). Methods A total of 122 patients with persistent AF who were admitted to the Second Department of Cardiovascular Medicine, Zhangzhou Municipal Hospital of Fujian Province from June 2020 to November 2022 were randomly divided into HPSD group (n=61) and routine group (n=61). Bilateral pulmonary venous isolation (PVI) by the modified BOXI ablation in the HPSD group, and that by low-power long-term ablation in the routine group were performed. A cold saline perfusion pressure sensing catheter with a power setting of 45 W, guided by the ablation index was given in the HPSD group. Ablation at 35 W for 25-30 seconds was performed in the routine group, and the ablation index and pressure index were consistent with those of the HPSD group. Baseline data, time to complete PVI and modified BOXI, total operation time, perioperative complications, and non-atrial arrhythmia rate at 12 months after a single operation were compared between the two groups. Results The time to complete bilateral pulmonary vein isolation and modified BOXI and the total operation time in the HPSD group were significantly shorter than those of the routine group (P<0.05). There was 1 case of postoperative pericardial tamponade in the routine group. No esophageal injury, stroke or transient ischemic attack and pulmonary vein stenosis or death occurred in both groups. The non-atrial arrhythmia rate was 70.5% in the HPSD group and 63.9% in the routine group at 12 months after a single surgery, showing no significant difference (P=0.440). There was no significant difference in the recovery rate of pulmonary vein and modified BOX potential between the two groups during the second operation (P>0.05). Conclusion The use of HPSD in the modified BOXI procedure for persistent AF is effective, feasible, and safe, which significantly reduces total ablation time and procedure time without compromising clinical efficacy.

Key words: atrial fibrillation, BOXI, catheter ablation, high power

CLC Number:

R541.75

Zhu Chunyu, Lin Chunyi, Weng Lan, Yang Xunjie, Dong Dihui. Efficacy and safety of high-power short-duration on the modified box isolation for persistent atrial fibrillation[J]. Clinical Focus, 2024, 39(10): 915-920.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.10.008

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I10/915

Figures/Tables 5

References 25

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组别	例数	年龄 (岁)	男性 [例(%)]	房颤类型[例(%)]		左心房前后径 (mm)	左室舒张末径 (mm)	左室射血分数 (%)	CHA2DS2-VASc 评分(分)
组别	例数	年龄 (岁)	男性 [例(%)]	持续性房颤	长程持续性房颤	左心房前后径 (mm)	左室舒张末径 (mm)	左室射血分数 (%)	CHA2DS2-VASc 评分(分)
HPSD组	61	61.9±10.5	43(70.5)	40 (65.6)	33(54.1)	37.6±6.6	47.1±6.4	58.1±8.4	1.6±1.3
常规组	61	60.1±10.8	46(75.4)	21 (34.4)	28(45.9)	31.9±5.8	46.1±4.0	60.3±6.3	1.4±1.1
t/χ²值		0.902	0.374	1.671		4.979	1.031	-1.713	1.044
P值		0.925	0.541	0.196		0.234	0.304	0.089	0.299

组别	例数	年龄 (岁)	男性 [例(%)]	房颤类型[例(%)]		左心房前后径 (mm)	左室舒张末径 (mm)	左室射血分数 (%)	CHA2DS2-VASc 评分(分)
组别	例数	年龄 (岁)	男性 [例(%)]	持续性房颤	长程持续性房颤	左心房前后径 (mm)	左室舒张末径 (mm)	左室射血分数 (%)	CHA2DS2-VASc 评分(分)
HPSD组	61	61.9±10.5	43(70.5)	40 (65.6)	33(54.1)	37.6±6.6	47.1±6.4	58.1±8.4	1.6±1.3
常规组	61	60.1±10.8	46(75.4)	21 (34.4)	28(45.9)	31.9±5.8	46.1±4.0	60.3±6.3	1.4±1.1
t/χ²值		0.902	0.374	1.671		4.979	1.031	-1.713	1.044
P值		0.925	0.541	0.196		0.234	0.304	0.089	0.299

组别	例数	每个位点消融时间(s)	消融时间 (min)	手术总时间 (min)	射频总能量 (kJ)	射线时间 (min)	射线量 (mGy)	BOX内补点数(个)	房性心律失常诱发[例(%)]	POP数 (个)
HPSD组	61	14.3±3.7	103.0±30.4	204.4±28.7	159.5±19.6	3.2±1.7	3.9±5.1	11.9±2.6	9(14.8)	1.2±1.0
常规组	61	30.3±2.9	126.3±31.4	233.1±30.6	193.0±21.2	3.0±1.7	6.9±17.2	18.6±3.6	13(21.3)	1.0±1.1
t/χ²值		-26.345	-4.164	-5.343	-9.082	0.673	-1.315	-11.701	0.887	0.743
P值		<0.001	<0.001	<0.001	<0.001	0.502	0.191	<0.001	0.346	0.459

组别	例数	每个位点消融时间(s)	消融时间 (min)	手术总时间 (min)	射频总能量 (kJ)	射线时间 (min)	射线量 (mGy)	BOX内补点数(个)	房性心律失常诱发[例(%)]	POP数 (个)
HPSD组	61	14.3±3.7	103.0±30.4	204.4±28.7	159.5±19.6	3.2±1.7	3.9±5.1	11.9±2.6	9(14.8)	1.2±1.0
常规组	61	30.3±2.9	126.3±31.4	233.1±30.6	193.0±21.2	3.0±1.7	6.9±17.2	18.6±3.6	13(21.3)	1.0±1.1
t/χ²值		-26.345	-4.164	-5.343	-9.082	0.673	-1.315	-11.701	0.887	0.743
P值		<0.001	<0.001	<0.001	<0.001	0.502	0.191	<0.001	0.346	0.459

组别	例数	肺静脉恢复	LSPV	LIPV	RSPV	RIPV	BOX恢复
HPSD组	8	4(50.0)	4(50.0)	2(25.0)	2(25.0)	2(25.0)	6(75.0)
常规组	12	8(66.7)	6(50.0)	4(33.3)	4(33.3)	4(33.3)	8(66.7)
χ²值		0.556	0.000	0.000	0.000	0.000	0.159
P值		0.456	1.000	1.000	1.000	1.000	0.690