Katsiyiannis William T, Melby Daniel P, Matelski Jayme L, Ervin Vanessa L, Laverence Kerri L, Gornick Charles C
Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Am J Cardiol. 2008 Dec 15;102(12):1674-6. doi: 10.1016/j.amjcard.2008.08.012. Epub 2008 Oct 30.
Radiofrequency ablation for atrial fibrillation (AF) involves complex catheter manipulation resulting in prolonged procedure time and fluoroscopy exposure. Remote magnetic navigation (RMN) represents a novel approach toward improving the ability to perform complex ablation. Forty patients underwent ablation for AF, 20 using RMN (NIOBE II, Stereotaxis, Inc) with a 4-mm-tip magnetic catheter (Celsius, Biosense Webster) and 20 using a conventional 8-mm-tip bidirectional ablation catheter (Blazer, Boston Scientific). All patients underwent a combined wide area circumferential ablation and segmental pulmonary vein (PV) isolation using a circular mapping catheter and cavotricuspid isthmus ablation for right atrial flutter. The procedural end point was PV entrance block. There was no difference in atrial size, left ventricular systolic function, or type of AF between groups. PV entrance block was achieved in all patients. Mean procedure time was 279 +/- 60 minutes in the conventional group versus 209 +/- 56 minutes in the RMN group (p <0.001). Mean fluoroscopy time in the conventional group was 58.6 +/- 21 minutes versus 19.5 +/- 9.8 in the RMN group (p <0.001). At 1 year there were 15 patients in the conventional group and 16 in the RMN group free from clinical AF and off antiarrhythmic drugs (p = NS). There were 2 additional ablations performed for atypical atrial flutter in the conventional group and 3 in the RMN group (p = ns). Ablation catheter char formation was not observed. There were no procedural complications. In conclusion, radiofrequency ablation of AF performed with RMN is safe and feasible. Compared with conventional hand-navigated ablation, RMN ablation results in similar clinical outcomes with decreased fluoroscopy and procedure times.
用于治疗心房颤动（AF）的射频消融术涉及复杂的导管操作，导致手术时间延长和透视曝光时间增加。远程磁导航（RMN）是一种提高进行复杂消融能力的新方法。40例患者接受了AF消融治疗，20例使用RMN（NIOBE II，Stereotaxis公司）和4毫米尖端磁导管（Celsius，Biosense Webster），20例使用传统的8毫米尖端双向消融导管（Blazer，波士顿科学公司）。所有患者均使用环形标测导管进行了大面积环周消融和节段性肺静脉（PV）隔离，并对右房扑动进行了腔静脉峡部消融。手术终点为PV入口阻滞。两组之间在心房大小、左心室收缩功能或AF类型方面无差异。所有患者均实现了PV入口阻滞。传统组的平均手术时间为279±60分钟，而RMN组为209±56分钟（p<0.001）。传统组的平均透视时间为58.6±21分钟，而RMN组为19.5±9.8分钟（p<0.001）。1年后，传统组有15例患者、RMN组有16例患者无临床AF且停用抗心律失常药物（p=无统计学意义）。传统组有2例因非典型房扑进行了额外消融，RMN组有3例（p=无统计学意义）。未观察到消融导管炭化形成。无手术并发症。总之，使用RMN进行AF的射频消融是安全可行的。与传统的手动导航消融相比，RMN消融导致类似的临床结果，同时减少了透视和手术时间。
