Schwagten Bruno, Jordaens Luc, Rivero-Ayerza Maximo, Van Belle Yves, Knops Paul, Thornton Ing Andrew, Szili-Torok Tamas
Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Pacing Clin Electrophysiol. 2010 Nov;33(11):1298-303. doi: 10.1111/j.1540-8159.2010.02810.x.
Radiofrequency catheter ablation of left-sided accessory pathways (APs) can be performed either by a transseptal (TS) or transaortic (TA) approach. When performed manually, these techniques are equally effective. The aim of this prospective randomized study was to compare these approaches using a magnetic navigation system (MNS) (Niobe, Stereotaxis, St. Louis, MO, USA).
Twenty-two consecutive patients were randomized to undergo ablation of a left-sided AP by either a TS or a TA approach. The MNS was used in all patients for catheter navigation and eventual ablation, after electrophysiology study (EPS) confirmed the presence of left-sided APs. Crossover was allowed after failure of the initial approach. Success rates, procedure, fluoroscopy, and ablation times were compared.
Of 11 procedures, 10 (91%) were successful in the TS group. The patient crossed over to the TA approach remained unsuccessful. Successful elimination of the AP was obtained in nine (82%) of 11 of the TA procedures. Of the two patients who crossed over to a TS procedure in the same session, one was successful and one remained unsuccessful. Total procedure time did not differ in both groups (87.1 ± 30.8 vs 90.9 ± 26.5 minutes). When total procedure and patient fluoroscopy times were divided into EPS time, time to first application, to successful application, and time to perform TS puncture or to retrogradely cross the aortic valve, only the last measurement differed significantly for both groups (P < 0.01). Ablation times were comparable in both groups. No major complications occurred.
Our data show that TS and TA approaches are equal in success rate and total procedure, patient fluoroscopy, and ablation time when using the MNS for left-sided AP ablation. However, crossing the aortic valve with the MNS is faster than completing a TS puncture.
左侧旁路（AP）的射频导管消融可通过经间隔（TS）或经主动脉（TA）途径进行。手动操作时，这些技术同样有效。这项前瞻性随机研究的目的是使用磁导航系统（MNS）（Niobe，Stereotaxis，美国密苏里州圣路易斯）比较这些途径。
连续22例患者被随机分为经TS或TA途径进行左侧AP消融。在电生理研究（EPS）证实存在左侧AP后，所有患者均使用MNS进行导管导航并最终消融。初始方法失败后允许交叉。比较成功率、手术时间、透视时间和消融时间。
在11例手术中，TS组10例（91%）成功。转为TA途径的患者仍未成功。TA组11例手术中有9例（82%）成功消除了AP。在同一会诊中转为TS手术的2例患者中，1例成功，1例仍未成功。两组总手术时间无差异（87.1±30.8 vs 90.9±26.5分钟）。当将总手术时间和患者透视时间分为EPS时间、首次应用时间、成功应用时间以及进行TS穿刺或逆行穿过主动脉瓣的时间时，两组仅最后一项测量结果有显著差异（P<0.01）。两组消融时间相当。未发生重大并发症。
我们的数据表明，在使用MNS进行左侧AP消融时，TS和TA途径在成功率、总手术时间、患者透视时间和消融时间方面相当。然而，使用MNS穿过主动脉瓣比完成TS穿刺更快。
