Chun Julian Kyoung-Ryul, Ernst Sabine, Matthews Shibu, Schmidt Boris, Bansch Dietmar, Boczor Sigrid, Ujeyl Amaar, Antz Matthias, Ouyang Feifan, Kuck Karl-Heinz
Department of Cardiology, Asklepios Klinik St Georg Hospital, Lohmuehlenstr. 5, Hamburg 20099, Germany.
Eur Heart J. 2007 Jan;28(2):190-5. doi: 10.1093/eurheartj/ehl447. Epub 2007 Jan 11.
This study evaluates feasibility, safety, and efficacy of magnetic remote-controlled accessory pathway (AP) ablation.
The novel magnetic navigation system (MNS) (Niobe, Stereotaxis) creates a steerable magnetic field (0.08 T) controlling the distal magnetic tip of an ablation catheter. In conjunction with a catheter advancer system (Cardiodrive, Stereotaxis) remote catheter ablation is enabled. Conventional electrophysiology study identified AP conduction in 59 patients (37 males, 36+/-14 years, 60 APs). First generation 1-magnet tip (1-M) (group I, n=18), second generation bipolar 3-magnet tip (3-M) (group II, n=27), and third generation quadripolar 3-magnet tip catheters (3-M quad.) (group III, n=14) were used for magnetic remote-controlled ablation. Successful AP ablation was achieved in 67% (group I), 85% (group II), and 92% (group III). A significant decrease of median [IQR: Q1-Q3] fluoroscopy time and dosage was observed: 21.2 [12.1-33.8] min, 1110 [395-3234] microGym2 (group I); 6.5 [4.4-15.4] min, 290 [129-489] microGym2 (group II), and 4.9 [3.4-8.0] min, 129 [74-270] microGym2 (group III). Mean procedure time (217+/-67 min; 182+/-68 min, and 172+/-90 min) significantly decreased in group III. Median number [Q1-Q3] of radiofrequency current applications in groups I, II, and III was 4 [2-9], 4 [2-6], and 2 [2-4], respectively. No complications occurred.
Remote AP ablation is safe and feasible using the novel MNS. Introduction of the 3-magnet quadripolar ablation catheter significantly improved the efficacy of the procedure.
本研究评估磁控旁道（AP）消融的可行性、安全性和有效性。
新型磁导航系统（MNS）（Niobe，Stereotaxis公司）可产生一个可控的磁场（0.08T），用于控制消融导管的远端磁头。结合导管推进系统（Cardiodrive，Stereotaxis公司），实现了远程导管消融。常规电生理研究在59例患者（37例男性，年龄36±14岁，60条旁道）中发现了AP传导。第一代单磁头（1-M）（I组，n = 18）、第二代双极三磁头（3-M）（II组，n = 27）和第三代四极三磁头导管（3-M quad.）（III组，n = 14）用于磁控远程消融。I组、II组和III组的AP消融成功率分别为67%、85%和92%。透视时间和剂量的中位数[四分位间距：Q1-Q3]显著降低：I组为21.2[12.1-33.8]分钟，1110[395-3234]微戈瑞²；II组为6.5[4.4-15.4]分钟，290[129-489]微戈瑞²；III组为4.9[3.4-8.0]分钟，129[74-270]微戈瑞²。III组的平均手术时间（217±67分钟；182±68分钟和）显著缩短。I组、II组和III组的射频电流应用次数中位数[Q1-Q分别为4[2-9]、4[2-6]和2[2-4]。未发生并发症。
使用新型MNS进行远程AP消融是安全可行的。三磁头四极消融导管的引入显著提高了手术疗效。
