Schneider Michael A E, Ndrepepa Gjin, Dobran Ildiko, Schreieck Jürgen, Weber Stefan, Plewan Andreas, Deisenhofer Isabel, Karch Martin R, Schömig Albert, Schmitt Claus
Deutsches Herzzentrum and I. Medizinische Klinik, Technische Universität München, Munich, Germany.
J Cardiovasc Electrophysiol. 2003 Jun;14(6):587-90. doi: 10.1046/j.1540-8167.2003.03017.x.
Catheter ablation has become a well-established therapy for isthmus-dependent right atrial flutter (AFL). Recently, mapping and ablation of AFL have been performed using sophisticated three-dimensional mapping systems, such as electroanatomic and noncontact mapping systems. The LocaLisa system enables nonfluoroscopic navigation of intracardiac electrode catheters based on impedance changes related to catheter movements in transthoracic current fields. The aim of this randomized prospective study was to compare the efficacy of the LocaLisa system with the conventional mapping/ablation approach for radiofrequency ablation of AFL.
Fifty consecutive patients with AFL (39 men and 11 women; age 65 +/- 10 years) were studied. The patients were randomly assigned to undergo radiofrequency ablation guided by a conventional fluoroscopy-based approach (24 patients) or by the LocaLisa system (26 patients). Ablation success rate and documentation of bidirectional isthmus block were 100% in both groups. Compared with fluoroscopy-guided approaches, LocaLisa-guided procedures demonstrated a reduction in total fluoroscopy time from 15.9 +/- 10.6 minutes to 7.5 +/- 6.5 minutes (P < 0.005). Total fluoroscopy dosage was reduced from 21.0 +/- 19.8 to 8.7 +/- 9.5 Gycm2 (P < 0.05). Fluoroscopy time required for ablation was significantly shortened in the LocaLisa group (2.6 +/- 2.6 min) compared with the conventional approach group (11 +/- 10 min, P < 0.0005). In 9 (35%) of 26 patients, the ablation could be performed with a fluoroscopy time < or = 1 minute. There were no significant differences with regard to the number of radiofrequency applications, fluoroscopy time needed for diagnostic reasons, total procedure time, or other ablation data.
Compared with the conventional approach, the LocaLisa system significantly reduces the fluoroscopy times needed for ablation of typical AFL.
导管消融已成为峡部依赖性右房扑动（AFL）的一种成熟治疗方法。近来，已使用复杂的三维标测系统（如电解剖标测系统和非接触标测系统）来进行AFL的标测和消融。LocaLisa系统能够基于与经胸电流场中导管移动相关的阻抗变化，实现心内电极导管的非透视导航。本随机前瞻性研究的目的是比较LocaLisa系统与传统标测/消融方法在AFL射频消融中的疗效。
对50例连续的AFL患者（39例男性和11例女性；年龄65±10岁）进行了研究。患者被随机分配接受基于传统透视方法引导的射频消融（24例患者）或LocaLisa系统引导的射频消融（26例患者）。两组的消融成功率和双向峡部阻滞的记录均为100%。与透视引导方法相比，LocaLisa引导的手术显示总透视时间从15.9±10.6分钟减少至7.5±6.5分钟（P<0.005）。总透视剂量从21.0±19.8降至8.7±9.5 Gycm2（P<0.05）。与传统方法组（11±10分钟，P<0.0005）相比，LocaLisa组消融所需的透视时间显著缩短（2.6±2.6分钟）。在26例患者中的9例（35%）中，消融可在透视时间≤1分钟的情况下进行。在射频应用次数、诊断所需的透视时间、总手术时间或其他消融数据方面，无显著差异。
与传统方法相比，LocaLisa系统显著减少了典型AFL消融所需的透视时间。
