Martinek Martin, Nesser Hans-Joachim, Aichinger Josef, Boehm Gernot, Purerfellner Helmut
Department of Cardiology, Public Hospital Elisabethinen, Academic Teaching Hospital, Linz, Austria.
Pacing Clin Electrophysiol. 2007 Oct;30(10):1215-23. doi: 10.1111/j.1540-8159.2007.00843.x.
Circumferential radiofrequency catheter ablation (RFCA) around the orifices of the pulmonary veins (PV) is a curative catheter-based therapy of paroxysmal, persistent, and permanent atrial fibrillation (AF). Integration of multislice computed tomography into three-dimensional electroanatomic mapping to guide catheter ablation has been shown to be accurate and feasible. This study investigated whether the use of such sophisticated imaging technology translates into better clinical outcomes, procedural efficacy, and safety in comparison with a control group treated with conventional three-dimensional electroanatomic mapping.
A total of 100 consecutive patients (85 male, mean age 55 +/- 9 years) with multi-drug-resistant AF underwent RFCA. In this study we used a wide area circumferential approach with confirmed PV isolation (requiring additional ablations at the ostial level) and further lines as needed.
Comparison of outcome data between the conventional electroanatomic mapping (Carto XP, Biosense Webster, Diamond Bar, CA, USA) and the image integration technology (Carto MERGE, Biosense Webster) resulted in a significant improvement in procedural success for the image integration group (85.1% vs 67.9%; P = 0.018). No single case of significant PV stenosis occurred in the Carto MERGE group versus three significant stenoses in the conventional group (P = 0.098). Both procedure and fluoroscopy times remained unchanged.
Multislice computed tomography image integration into electroanatomic mapping significantly improves the success of wide area circumferential ablation with confirmed isolation of the PV and additional lines. In addition, the safety of radiofrequency ablation with regard to the occurrence of PV stenosis is increased in comparison with a control group using conventional electroanatomic mapping alone. Procedural efficacy remains unchanged.
环绕肺静脉口进行环周射频导管消融术（RFCA）是一种基于导管的治疗阵发性、持续性及永久性心房颤动（AF）的根治性疗法。多层螺旋计算机断层扫描与三维电解剖标测相结合以指导导管消融已被证明是准确且可行的。本研究调查了与采用传统三维电解剖标测治疗的对照组相比，使用这种先进的成像技术是否能带来更好的临床结局、手术疗效及安全性。
共有100例连续的多药耐药性AF患者（85例男性，平均年龄55±9岁）接受了RFCA。在本研究中，我们采用了一种广泛的环周方法，确认肺静脉隔离（在开口水平需要额外消融）并根据需要进行进一步的线性消融。
传统电解剖标测（Carto XP，美国加利福尼亚州钻石吧市Biosense Webster公司）与图像整合技术（Carto MERGE，Biosense Webster公司）的结局数据比较显示，图像整合组的手术成功率有显著提高（85.1%对67.9%；P = 0.018）。Carto MERGE组未发生一例严重肺静脉狭窄，而传统组有三例严重狭窄（P = 0.098）。手术时间和透视时间均保持不变。
多层螺旋计算机断层扫描图像整合到电解剖标测中显著提高了在确认肺静脉隔离及额外线性消融的情况下广泛环周消融的成功率。此外，与仅使用传统电解剖标测的对照组相比，射频消融在肺静脉狭窄发生方面的安全性有所提高。手术疗效保持不变。
