Willems S, Weiss C, Ventura R, Rüppel R, Risius T, Hoffmann M, Meinertz T
Department of Cardiology, University Hospital Eppendorf, Hamburg, Germany.
J Cardiovasc Electrophysiol. 2000 Nov;11(11):1223-30. doi: 10.1046/j.1540-8167.2000.01223.x.
Three-dimensional electroanatomic (CARTO) activation mapping of the cavotricuspid isthmus can be helpful to guide atrial flutter ablation, but to date has not been investigated in comparison to conventional strategies. The aim of the present study was to assess the efficacy of the CARTO navigation system, especially with respect to the fluoroscopy time required for successful atrial flutter ablation.
Eighty patients with recurrent common-type atrial flutter were randomly assigned to temperature-controlled radiofrequency (RF) catheter ablation, either guided by conventional criteria (group 1) or additionally oriented on electroanatomic mapping (group 2). In all patients, similar multipolar catheters were inserted into the coronary sinus and placed at the tricuspid annulus, respectively. In group 2, positioning of the mapping electrode and delivery of RF pulses within the cavotricuspid isthmus was mainly oriented on the CARTO map to achieve the most linear and continuous RF lesions. Abolition of intra-atrial conduction verified by conventional criteria (group 1) and electroanatomic mapping (group 2) could be verified in all patients. The overall number of RF pulses (group 1: 16.7+/-6.5; group 2: 13.2+/-5.3) and mean procedure duration (group 1: 172.5+/-47.4 min; group 2: 169.3+/-47.3 min) were not different between the two groups, but mean fluoroscopy time was significantly shorter when the CARTO technology was used (group 1: 29.2+/-9.4 min; group 2: 7.7+/-2.8 min; P = 0.0001). Recurrence of atrial flutter was observed in 3 (9%) patients in each group after a mean follow-up of 8.5+/-2.8 months.
Atrial flutter can be abolished effectively using the conventional technique as well as oriented on electroanatomic mapping. However, overall X-ray exposure can be significantly reduced by the CARTO-guided approach without prolongation of procedure duration.
三尖瓣峡部的三维电解剖（CARTO）激动标测有助于指导心房扑动消融，但迄今为止，与传统策略相比尚未进行过研究。本研究的目的是评估CARTO导航系统的疗效，尤其是在成功进行心房扑动消融所需的透视时间方面。
80例复发性常见型心房扑动患者被随机分配接受温控射频（RF）导管消融，一组采用传统标准指导（第1组），另一组在电解剖标测的辅助下进行（第2组）。所有患者均分别将类似的多极导管插入冠状窦并置于三尖瓣环处。在第2组中，峡部内标测电极的定位和RF脉冲的发放主要依据CARTO图进行，以形成最线性和连续的RF损伤。通过传统标准（第1组）和电解剖标测（第2组）证实所有患者的房内传导均被消除。两组之间的RF脉冲总数（第1组：16.7±6.5；第2组：13.2±5.3）和平均手术时间（第1组：172.5±47.4分钟；第2组：169.3±47.3分钟）无差异，但使用CARTO技术时平均透视时间明显更短（第1组：29.2±9.4分钟；第2组：7.7±2.8分钟；P = 0.0001）。平均随访8.5±2.8个月后，每组均有3例（9%）患者出现心房扑动复发。
使用传统技术以及基于电解剖标测均可有效消除心房扑动。然而，CARTO指导的方法可显著减少总体X线暴露，且不延长手术时间。
