Thornton Andrew S, Jordaens Luc J
Department of Clinical Electrophysiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands.
Heart Rhythm. 2006 Jun;3(6):691-6. doi: 10.1016/j.hrthm.2006.01.028. Epub 2006 Feb 28.
Navigation, mapping, and ablation in the right ventricular outflow tract (RVOT) can be difficult. Catheter navigation using external magnetic fields may allow more accurate mapping and ablation.
The purpose of this study was to assess the feasibility of RVOT tachycardia ablation using remote magnetic navigation.
Mapping and ablation were performed in eight patients with outflow tract ventricular arrhythmias. Tachycardia mapping was undertaken with a 64-polar basket catheter, followed by remote activation and pace-mapping using a magnetically enabled catheter. The area of interest was localized on the basket catheter in seven patients in whom an RVOT arrhythmia was identified. Remote navigation of the magnetic catheter to this area was followed by pace-mapping. Ablation was performed at the site of perfect pace-mapping, with earliest activation if possible.
Acute success was achieved in all patients (median four applications). Median procedural time was 144 minutes, with 13.4 minutes of patient fluoroscopy time and 3.8 minutes of physician fluoroscopy time. No complications occurred. One recurrence occurred during follow-up (mean 366 days).
RVOT tachycardias can be mapped and ablated using remote magnetic navigation, initially guided by a basket catheter. Precise activation and pace-mapping are possible. Remote magnetic navigation permitted low fluoroscopy exposure for the physician. Long-term results are promising.
右心室流出道（RVOT）的标测、定位及消融可能具有挑战性。利用外部磁场进行导管导航或许能实现更精确的标测与消融。
本研究旨在评估使用远程磁导航进行RVOT心动过速消融的可行性。
对8例流出道室性心律失常患者进行标测和消融。使用64极篮状导管进行心动过速标测，随后使用可磁控导管进行远程激动和起搏标测。在7例确诊为RVOT心律失常的患者中，通过篮状导管确定感兴趣区域。将磁控导管远程导航至该区域后进行起搏标测。在起搏标测完美且尽可能最早激动的部位进行消融。
所有患者均取得急性成功（中位数为4次操作）。手术时间中位数为144分钟，患者透视时间为13.4分钟，术者透视时间为3.8分钟。未发生并发症。随访期间有1例复发（平均366天）。
RVOT心动过速可在篮状导管初步引导下，使用远程磁导航进行标测和消融。能够实现精确的激动和起搏标测。远程磁导航使术者的透视暴露时间较短。长期效果良好。
