远程磁导航在常见型心房扑动患者行三尖瓣峡部消融中的应用。
Remote magnetic catheter navigation for cavotricuspid isthmus ablation in patients with common-type atrial flutter.
机构信息
Division of Cardiology and Pneumology, Heart Center, University of Göttingen, Göttingen, Germany.
出版信息
Circ Arrhythm Electrophysiol. 2009 Dec;2(6):603-10. doi: 10.1161/CIRCEP.109.884411.
BACKGROUND
Conventional catheter ablation of cavotricuspid isthmus (CTI)-dependent atrial flutter is a widely applied standard therapy. Remote magnetic catheter navigation (RMN) may provide benefits for different ablation procedures, but its efficacy for CTI ablation has not been evaluated in a randomized, controlled trial.
METHODS AND RESULTS
Ninety patients undergoing de novo ablation of atrial flutter were randomly assigned to conventional manual (n=45) or RMN-guided (n=45) CTI ablation with an 8-mm-tip catheter. Complete bidirectional isthmus block was achieved in 84% (RMN) and 91% (conventional catheter ablation) of the cases (P=0.52). RMN was associated with shorter fluoroscopy time (median, 10.6 minutes; interquartile range [IQR], 7.6 to 19.9, versus 15.0 minutes; IQR, 11.5 to 23.1; P=0.043) but longer total radiofrequency application (17.1 minutes; IQR, 8.6 to 25, versus 7.5 minutes; IQR, 3.6 to 10.9; P<0.0001), ablation time (55 minutes; IQR, 28 to 76, versus 17 minutes; IQR, 7 to 31; P<0.0001), and procedure duration (114+/-35 versus 77+/-24 minutes, P<0.0001). Procedure duration in the RMN group did not decrease significantly with case experience. Long-term procedure success, defined as achievement of complete CTI block and freedom from atrial flutter recurrence during 6 months of follow-up, was lower in the RMN group (73% versus 89%, P=0.063). Right atrial angiography after ablation revealed no significant differences between groups in terms of right atrial diameter or CTI length, morphology, and angulation. Furthermore, none of these parameters was predictive for difficult (ablation time >20 minutes) or unsuccessful ablation.
CONCLUSIONS
RMN-guided CTI ablation is associated with reduced radiation exposure but prolonged ablation and procedure times as compared with conventional catheter navigation. Our findings suggest that ablation lesions produced with an RMN-guided 8-mm catheter are less effective irrespective of CTI anatomy.
TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT00560872.
背景
传统的导管消融治疗依赖于心房峡部的房扑，是一种广泛应用的标准治疗方法。远程磁导航（RMN）可能对不同的消融程序有益，但它在随机对照试验中对峡部消融的疗效尚未得到评估。
方法和结果
90 例首次接受房扑消融的患者被随机分为传统手动（n=45）或 RMN 引导（n=45）的 8 毫米尖端导管消融治疗组。84%（RMN）和 91%（传统导管消融）的患者实现了完全双向峡部阻滞（P=0.52）。RMN 与较短的透视时间相关（中位数 10.6 分钟；四分位距 [IQR]，7.6 至 19.9，与 15.0 分钟；IQR，11.5 至 23.1；P=0.043），但总射频应用时间更长（17.1 分钟；IQR，8.6 至 25，与 7.5 分钟；IQR，3.6 至 10.9；P<0.0001），消融时间（55 分钟；IQR，28 至 76，与 17 分钟；IQR，7 至 31；P<0.0001）和手术时间（114+/-35 与 77+/-24 分钟，P<0.0001）。RMN 组的手术时间并没有随着病例经验的增加而显著减少。长期手术成功率定义为在 6 个月的随访期间完全阻断峡部并无房扑复发，RMN 组较低（73%比 89%，P=0.063）。消融后右心房造影显示两组在右心房直径或峡部长度、形态和角度方面无明显差异。此外，这些参数都不能预测困难（消融时间>20 分钟）或不成功的消融。
结论
与传统导管导航相比，RMN 引导的 CTI 消融与辐射暴露减少相关，但消融和手术时间延长。我们的研究结果表明，使用 RMN 引导的 8 毫米导管产生的消融灶效果较差，无论 CTI 解剖结构如何。
试验注册
clinicaltrials.gov 标识符：NCT00560872。
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