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Katheterablation von Vorhofflimmern

Pulmonalvenenisolation mit einem neuen multipolaren Ablationskatheter

Catheter ablation of atrial fibrillation

Pulmonary vein isolation by using a new multipolar ablation catheter

  • Published:
Clinical Research in Cardiology Supplements Aims and scope

Zusammenfassung

Die Katheterablation von Vorhofflimmern (VHF) hat sich in den letzten Jahren zunehmend in der Behandlung vor allem des paroxysmalen Vorhofflimmerns etabliert. In dieser Arbeit werden die Ergebnisse mit dem Einsatz des PVAC-Multielektroden-Ablationskatheters (PVAC®, Medtronic Ablation Frontiers, Carlsbad, CA, USA) vorgestellt. Insgesamt 253 Patienten mit paroxysmalem und persistierendem Vorhofflimmern wurden in die Studie aufgenommen. Es wurden insgesamt 1051 Pulmonalvenen (PV) isoliert, darunter auch 34 gemeinsame Ostien links und 1 gemeinsames Ostium rechts abladiert. Bis auf eine Vene konnten bei allen Patienten alle Zielvenen elektrisch isoliert werden. Bei 23 Patienten (9 %) wurde bei dokumentiertem typischen Vorhofflattern in gleicher Sitzung zusätzlich auch der rechtsatriale Isthmus abladiert. Nachkontrollen fanden jeweils 1, 3, 6 und 12 Monate nach der Ablation mittels 12-Kanal-EKG, Langzeit-EKG sowie 4-Tages-Holter-EKG statt. Belastbare Nachbeobachtungsdaten lagen von 221 Patienten vor. In einer Follow-up-Zeit von 11 ± 7 Monaten und mit einer Eingriffshäufigkeit von 1,1 pro Patient (24 Redo-Fälle) waren 122 von 181 (69 %) der Patienten mit paroxysmalem Vorhofflimmern im stabilen Sinusrhythmus; bei den Patienten mit persistierendem Vorhofflimmern waren es 23 von 40 (58 %). Insgesamt 159 Patienten (62,8 %) nahmen zum Zeitpunkt des letzten Follow-ups Antiarrhythmika ein; 214 Patienten hatten einen Betablocker (84,5 %). Die Durchleuchtungszeit betrug 16 ± 6 min bei einer Gesamtprozedurdauer von 71 ± 19 min. Prozedurbezogene Komplikationen wurde in 3 Fällen (1,2 %) beobachtet. Die Pulmonalvenenisolation mit dem PVAC-Ablationskatheter ist eine sichere, effektive und schnelle Methode zur Behandlung von paroxysmalem und persistierendem Vorhofflimmern.

Abstract

Catheter ablation of atrial fibrillation (AF) is an established therapeutical option, particularly in treatment of paroxysmal atrial fibrillation. This paper presents the results of using the PVAC multi-electrode ablation catheter (PVAC®, Medtronic Ablation Frontiers, Carlsbad, CA, USA). In 253 patients with paroxysmal or persistant AF, 1051 pulmonary veins were isolated, including ablation of 34 left common ostia and 1 right common ostium. Except one vein, all pulmonary veins in all patients were successfully isolated. In 23 patients with documented typical atrial flutter, the right atrial isthmus was additionally ablated within the same procedure. Follow-up (FU) visits were performed after 1, 3, 6 and 12 months with 12-lead-ECG, 24h-Holter-ECG and 4-days-Holter ECG. Mean FU was 11 ± 7 months with 1.1 interventions per patient (24 redo cases). During FU, 122 of 181 patients with paroxysmal AF (69%) and 23 of 40 patients with persistant AF (58%) were in stable sinus rhythm (SR) after ablation. 159 (62.8%) patients wer under antiarrhythmic drugs after ablation, 214 (84.5%) patients with additional β-blockers. Total procedure time was 71 ± 19 min, and total fluoroscopy time was 16 ± 6 min. In 3 cases (1.2%) procedure-related complications occured. Pulmonary vein isolation by using the PVAC-ablation catheter is a safe and effective method in treatment of paroxysmal and persistant AF.

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  1. Praxisklinik Herz und Gefäße, Kardiologie-Angiologie-Radiologie-Nuklearmedizin, Akademische Lehrpraxisklinik der TU Dresden, Forststraße 3, 01099, Dresden, Deutschland

    Stefan G. Spitzer &  Laszlo Karolyi

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Correspondence to Stefan G. Spitzer.

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Spitzer, S., Karolyi, L. Katheterablation von Vorhofflimmern. Clin Res Cardiol Suppl 6 (Suppl 1), 66–72 (2011). https://doi.org/10.1007/s11789-011-0034-2

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