Hindricks Gerhard, Willems Stefan, Kautzner Josef, De Chillou Christian, Wiedemann Michael, Schepel Siep, Piorkowski Christopher, Risius Tim, Kottkamp Hans
University of Leipzig, Heart Center, Cardiology, Department of Electrophysiology, Leipzig, Germany.
J Cardiovasc Electrophysiol. 2009 Jul;20(7):734-40. doi: 10.1111/j.1540-8167.2009.01439.x.
Radiofrequency catheter ablation of typical atrial flutter is one of the most frequent indications for catheter ablation in electrophysiology laboratories today. Clinical utility of electroanatomic mapping systems on treatment results and resource utilization compared with conventional ablation has not been systematically investigated in a prospective multicenter study.
In this prospective, randomized multicenter study, the results of catheter ablation to cure typical atrial flutter using conventional ablation strategy were compared with electroanatomically guided mapping and ablation (Carto). Primary endpoints of the study were procedure duration and fluoroscopy exposure time, secondary endpoints were acute success rate, recurrence rate, and resource utilization. A total of 210 patients (169 men, 41 women, mean age 63 +/- 10 years) with documented typical atrial flutter were included in the study. Acute ablation success, that is, demonstration of bidirectional isthmus block, was achieved in 99 of 105 patients (94%) in the electroanatomically guided ablation group and in 102 of 105 patients (97%) in the conventional ablation group (P > 0.05). Total procedure duration was comparable between both study groups (99 +/- 57 minutes vs 88 +/- 54 minutes, P > 0.05). Fluoroscopy exposure time was significantly shorter in the electroanatomically guided ablation group (7.7 +/- 7.3 minutes vs 14.8 +/- 11.9 minutes; P < 0.05). Total recurrence rate of typical atrial flutter at 6 months of follow-up was comparable between the 2 groups (respectively for the CARTO and conventional group 6.6% vs 5.7%, P > 0.05). The material costs per procedure in the electroanatomically guided and conventional groups (NaviStar DS vs Celsius DS) was 3035 euro (USD 3,870) and 2133 euro (USD 2,720), respectively.
This multicenter study documented that cavotricuspid isthmus ablation to cure typical atrial flutter was highly effective and safe, both in the conventional and the electroanatomically guided ablation group. The use of electroanatomical mapping system significantly reduced the fluoroscopy exposure time by almost 50%, however, at the expense of increased cost of the procedure.
射频导管消融典型心房扑动是当今电生理实验室中最常见的导管消融适应证之一。与传统消融相比，电解剖标测系统在治疗效果和资源利用方面的临床实用性尚未在前瞻性多中心研究中得到系统研究。
在这项前瞻性、随机多中心研究中，将使用传统消融策略治疗典型心房扑动的导管消融结果与电解剖引导标测和消融（Carto）进行比较。该研究的主要终点是手术持续时间和透视暴露时间，次要终点是急性成功率、复发率和资源利用。共有210例记录有典型心房扑动的患者（169例男性，41例女性，平均年龄63±10岁）纳入研究。电解剖引导消融组105例患者中有99例（94%）实现急性消融成功，即显示双向峡部阻滞；传统消融组105例患者中有102例（97%）实现急性消融成功（P>0.05）。两个研究组的总手术持续时间相当（99±57分钟对88±54分钟，P>0.05）。电解剖引导消融组的透视暴露时间明显更短（7.7±7.3分钟对14.8±11.9分钟；P<0.05）。随访6个月时，两组典型心房扑动的总复发率相当（Carto组和传统组分别为6.6%对5.7%，P>0.05）。电解剖引导组和传统组（NaviStar DS对Celsius DS）每次手术的材料成本分别为3035欧元（3870美元）和2133欧元（2720美元）。
这项多中心研究表明，在传统消融组和电解剖引导消融组中，经腔静脉三尖瓣峡部消融治疗典型心房扑动均高效且安全。使用电解剖标测系统可使透视暴露时间显著缩短近50%，然而，这是以增加手术成本为代价的。
