Comparative study of empirical ablation and quantitative ablation of paroxysmal atrial fibrillation

Jia Meixue; Ning Bin.

doi:10.3969/j.issn.1674-4055.2019.03.16

Abstract：Objective To investigate the clinical efficacy of quantitative ablation using the VisiTag module compared with previous empirical ablation in the radiofrequency ablation of paroxysmal atrial fibrillation, and to study the influencing factors of recurrence after radiofrequency ablation of atrial fibrillation. Methods Sixty-two patients with radiofrequency ablation due to paroxysmal atrial fibrillation from January 2017 to April 2018 were selected and divided into quantitative ablation group (group A, n=32, using VisiTag module) and experience ablation group (Group B, n=30). The parameters after VisiTag optimization are as follows: the maximum displacement range of the catheter displacement is ≤2.5 mm; the minimum time for the catheter to remain stable is >5 s; the catheter pressure is ≥5 g, the percentage of time for the minimum pressure is 25%; the diameter of the point is 3 mm, point and point overlapping each other. The differences in mean contact pressure, mean operative time, radiofrequency ablation time, number of ablation points, number of complications, unilateral isolation success rate, X-ray exposure time, and recurrence after 3 months were compared between the two groups. According to the follow-up results after 3 months, the patients were divided into atrial fibrillation recurrence group (Af group) and non-recurrence group (NAf group). Multivariate logistic stepwise regression analysis was performed to analyze the statistically significant factors in the univariate analysis. Independent risk factors for recurrence after radiofrequency ablation. Results After bilateral simple anatomical isolation of the simple pulmonary veins, the unilateral isolation rate of the patients in group A was higher than that in group B (P=0.021). Of the two groups, the mean contact pressure was higher in group A (P=0.006). The mean operative time, radiofrequency ablation time and X-ray exposure time of group A were significantly lower than those of group B. The recurrence rate was higher in group B after 3 months, 12 (40.0) cases in group A and 5 (16.7) cases in group B, P=0.032. Logistic stepwise regression analysis showed age (OR=1.120, P=0.450), hypertension (OR=3.621, P=0.470), left atrial diameter (OR=1.320, P=0.150) and single-circle isolation (OR=0.120, P=0.002) are independent predictors of recurrence of atrial fibrillation. Conclusion In the simple pulmonary vein isolation surgery for paroxysmal atrial fibrillation, VisiTag automatically measures the ablation injury system, which can safely and effectively reduce the conduction recovery between the left atrium and the pulmonary vein, and improve the clinical outcome of atrial fibrillation catheter radiofrequency ablation. Age, hypertension, left atrial enlargement, and non-unilateral isolation are independent predictors of AF recurrence.