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심방세동 전극도자 절제술 장기간 예후의 예측인자로서의 좌측 능선의 형태에 대한 고찰 : The Shape of the Left Lateral Ridge as a Good Predictor of Long Term outcome of Catheter Ablation for Atrial fibrillation:Based on Clinical and Experimental Data 원문보기

  • 저자

    김유리

  • 학위수여기관

    울산대학교

  • 학위구분

    국내박사

  • 학과

    의학과의학전공 내과학

  • 지도교수

    김유호

  • 발행년도

    2014

  • 총페이지

  • 키워드

    MDCT;left lateral ridge; AF; outcome; contact force;

  • 언어

    eng

  • 원문 URL

    http://www.riss.kr/link?id=T13540511&outLink=K  

  • 초록

    BACKGROUND: The left lateral ridge (LLR) between the left pulmonary vein (PV) and the left atrial appendage (LAA) was known as an important structure for atrial fibrillation (AF) ablation. The aim of the clinical study was to identify that the shape of the LLR is related to long term outcome of AF ablation. The experimental study investigates the relationship between the shape of the LLR and the RF lesion formation to support the results of the clinical outcome. METHODS: 1) Clinical study: we analyzed data from 247 consecutive patients who were referred for AF ablation. All patients underwent an ECG-gated 64 channels dual-source CT (MDCT). Patients were classified into 2 groups according to the shape of the LLR: “Narrow I-LLR” group (n=116, 47%) and “Wide V-LLR” group (n=131, 53%). 2) Experimental study: On the basis of the clinical data, two types of the ridge models were made with a porcine atrial tissue: a “Narrow ridge” and a “Wide ridge”. Three dimensional electro-anatomical mapping and RF ablations were performed on each ridge model with a contact force-sensing catheter. RESULTS: 1) Clinical Result: After a mean follow-up 475 ± 245 days, 182 (73.7%) of the patients maintained sinus rhythm after the initial ablation. In the 12 month follow-up, the AF-free survival rate was significantly higher in the wide V-LLR group than in the narrow I-LLR group (83.2% vs. 62.9% p=0.0004). A multivariate analysis showed that the shape of the LLR was an independent predictor of AF recurrence after ablation (Hazard ratio 2.58, 95% confidential interval 1.48-4.51, p=0.001). 2) Experimental Result: The mean contact force (CF) of the narrow ridge model was significantly lower than that of the wide ridge model (5.42±3.13g vs. 10.37±3.98g, p=0.001). In the narrow ridge models, ablation points along the ridge was scattered wider than in the wide ridge models. The total procedure time was similar between the two models (630±107 s vs. 585±91 s, p=0.229). However, the RF energy delivery time was significantly shorter in the narrow ridge model than in the wide ridge model (181.3±26.4 s vs. 307.8±69.2 s, p


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