Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France.
Heart Rhythm. 2010 Apr;7(4):459-65. doi: 10.1016/j.hrthm.2009.12.020. Epub 2010 Jan 4.
Theoretically, the use of electroanatomical mapping systems may reduce radiation exposure, while three-dimensional rotational atriography (3DATG) may increase exposure. Anatomical representation and image registration using 3DATG are likely to be superior, but the net clinical benefit of either system is unknown.
The purpose of this prospective randomized two-center study was to compare the procedural and clinical outcome of patients with atrial fibrillation (AF) treated by catheter ablation using either three-dimensional (3D) electroanatomical mapping (Carto) or 3DATG.
From November 2007 to November 2008, 91 consecutive patients with AF (mean age 58 +/- 10 years; 63% paroxysmal AF, 37% persistent AF) from two centers (Bordeaux and Boston) were randomized to ablation using either 3DATG (44 patients) or Carto (47 patients).
Of the 47 left atrial shells acquired with 3DATG, one was uninterpretable. There was no difference in total radiofrequency applications (72 +/- 23 vs. 79 +/- 33 minutes, respectively, P = .296), procedural duration (232 +/- 65 vs. 218 +/- 67 minutes; P = .335), fluroroscopic duration (75 +/- 28 vs. 67 +/- 26 minutes; P = .151), or radiation exposure (71,810 +/- 42,954 vs. 68,009 +/- 38,345 mGy cm(2); P = .719) between procedures performed with 3DATG or Carto. After a mean follow-up of 10 +/- 4 months, there was no difference in clinical outcome using either Carto or 3DATG concerning total arrhythmia recurrence (34% versus 38%; P = .668) or AF recurrence (20% vs. 15%; P = .555).
Three-dimensional ATG-guided AF ablation has similar radiation exposure and procedural and outcome characteristics compared with Carto-guided ablation. The ease of use and accurate 3D representation of the left atrium make 3DATG a reasonable alternative to conventional 3D electroanatomical mapping systems, however, without advanced mapping functions.
理论上，使用电解剖标测系统可能会降低辐射暴露，而三维旋转造影术（3DATG）可能会增加辐射暴露。使用 3DATG 进行解剖学表示和图像配准可能会更好，但两种系统的净临床获益尚不清楚。
本前瞻性随机双中心研究的目的是比较使用三维（3D）电解剖标测（Carto）或 3DATG 治疗心房颤动（AF）患者的手术过程和临床结局。
从 2007 年 11 月至 2008 年 11 月，来自两个中心（波尔多和波士顿）的 91 例连续 AF 患者（平均年龄 58 +/- 10 岁；63%阵发性 AF，37%持续性 AF）被随机分为使用 3DATG（44 例）或 Carto（47 例）消融治疗。
在 47 个左心房外壳中，有一个无法解释。两种方法的总射频应用次数（分别为 72 +/- 23 分钟和 79 +/- 33 分钟，P =.296）、手术时间（分别为 232 +/- 65 分钟和 218 +/- 67 分钟，P =.335）、透视时间（分别为 75 +/- 28 分钟和 67 +/- 26 分钟，P =.151）或辐射暴露（分别为 71,810 +/- 42,954 vs. 68,009 +/- 38,345 mGy cm(2)，P =.719）无差异。在平均随访 10 +/- 4 个月后，使用 Carto 或 3DATG 治疗的总心律失常复发率（34%与 38%；P =.668）或 AF 复发率（20%与 15%；P =.555）无差异。
与 Carto 引导消融相比，3DATG 引导的 AF 消融具有相似的辐射暴露和手术过程及结果特征。3DATG 易于使用，并且可以准确地表示左心房的 3D 结构，是传统的 3D 电解剖标测系统的合理替代方案，但是没有高级的标测功能。
