Di Biase Luigi, Burkhardt J David, Lakkireddy Dhanunjaya, Pillarisetti Jayasree, Baryun Esam Nuri, Biria Mazda, Horton Rodney, Sanchez Javier, Gallinghouse G Joseph, Bailey Shane, Beheiry Salwa, Hongo Richard, Hao Steven, Tomassoni Gery, Natale Andrea
Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA.
J Interv Card Electrophysiol. 2009 Nov;26(2):133-7. doi: 10.1007/s10840-009-9416-5. Epub 2009 Jul 29.
Remote magnetic navigation (RMN) has been reported as an effective and safe tool to overcome the need for advanced operator skill in the treatment of complex arrhythmias. We report a series of patients undergoing radiofrequency catheter ablation of ventricular arrhythmias (VAs) using RMN with either a 4-mm catheter tip or an 8-mm catheter tip at four different centers.
Sixty-five patients with clinical and symptomatic history of Vas were included. Two different magnetic catheters were used to deliver radiofrequency applications remotely. When ablation with the RMN catheters failed, a manual irrigated catheter was used to eliminate the VAs. Post-ablation pacing maneuvers were utilized to verify the inducibility of Vas.
Twenty-eight patients (43%) had ischemic cardiomyopathy [coronary artery disease (CAD)], 16 patients (25%) had non-ischemic cardiomyopathy [idiopathic dilated cardiomyopathy (IDC)], and 21 patients (32%) had structurally normal hearts (SNH) or right ventricle outflow tract tachycardia (RVOT). In patients with structural heart disease (CAD, IDC), success was achieved in 22% with the 4-mm catheter tip and in 59% with the 8-mm catheter tip (p = 0.014). In patients with SNH/RVOT, success was achieved in 85% with the 4-mm catheter tip and in 87% with the 8-mm catheter tip (p = 1.00).
Our findings showed that, with RMN, there is an increased success related to the catheter tip utilized. However, in patients with right ventricular outflow origin, the standard 4-mm tip provided adequate lesions for successful ablation in most patients.
据报道，远程磁导航（RMN）是一种有效且安全的工具，可满足治疗复杂心律失常时对高级操作员技能的需求。我们报告了在四个不同中心使用4毫米导管尖端或8毫米导管尖端的RMN对室性心律失常（VA）进行射频导管消融的一系列患者。
纳入65例有VA临床症状病史的患者。使用两种不同的磁导管远程进行射频应用。当RMN导管消融失败时，使用手动灌注导管消除VA。消融后起搏操作用于验证VA的可诱导性。
28例患者（43%）患有缺血性心肌病[冠状动脉疾病（CAD）]，16例患者（25%）患有非缺血性心肌病[特发性扩张型心肌病（IDC）]，21例患者（32%）心脏结构正常（SNH）或患有右心室流出道心动过速（RVOT）。在患有结构性心脏病（CAD、IDC）的患者中，4毫米导管尖端的成功率为22%，8毫米导管尖端的成功率为59%（p = 0.014）。在患有SNH/RVOT的患者中，4毫米导管尖端的成功率为85%，8毫米导管尖端的成功率为87%（p = 1.00）。
我们的研究结果表明，使用RMN时，与所使用的导管尖端相关的成功率有所提高。然而，在右心室流出道起源的患者中，标准的4毫米尖端在大多数患者中提供了足够的损伤以成功消融。
