Cardiac Arrhythmia Service, Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York 10029, USA.
Heart Rhythm. 2010 Nov;7(11):1644-53. doi: 10.1016/j.hrthm.2010.07.011. Epub 2010 Jul 14.
In performing catheter ablation of paroxysmal atrial fibrillation (PAF), the advent of electroanatomical mapping (EAM) has significantly reduced fluoroscopy time. Recent advances in the ability of EAM systems to simultaneously visualize multiple catheters have allowed some operators to perform certain procedures, such as catheter ablation of supraventricular tachycardias, with zero fluoroscopy use.
The purpose of this study was to evaluate the feasibility and safety of pulmonary vein (PV) isolation with zero fluoroscopy use, using a combination of three-dimensional EAM and intracardiac echocardiography (ICE).
Using the NavX EAM system, the right atrial (RA) and coronary sinus (CS) geometries were created without fluoroscopy. Fluoroless transseptal puncture was performed under ICE guidance. Using a deflectable sheath and a multipolar catheter, the left atrial (LA) and PV anatomies were rendered and, in select cases, integrated with a three-dimensional computed tomography (CT) image. Irrigated radiofrequency ablation was performed to encircle each pair of ipsilateral PVs.
This series included 20 consecutive PAF patients. RA/CS mapping required 5.5 ± 2.6 minutes. In all patients, single (n = 18) or dual (n = 2) transseptal access was successfully achieved. The LA-PV anatomy was rendered using either a circular (14 patients) or penta-array (six patients) catheter in 22 ± 10 minutes; CT image integration was used in 11 patients. Using 49 ± 18 ablation lesions/patient, electrical isolation was achieved in 38/39 ipsilateral PV isolating lesion sets (97%). The procedure time was 244 ± 75 minutes. There were no complications.
Completely fluoroless catheter ablation of paroxysmal AF is safely feasible using a combination of ICE and EAM.
在阵发性心房颤动（PAF）的导管消融中，电解剖标测（EAM）的出现显著减少了透视时间。EAM 系统同时显示多个导管的能力的最新进展使一些操作人员能够在不使用透视的情况下进行某些手术，例如室上性心动过速的导管消融。
本研究旨在评估使用三维 EAM 和心腔内超声（ICE）组合进行零透视肺静脉（PV）隔离的可行性和安全性。
使用 NavX EAM 系统，在不透视的情况下创建右心房（RA）和冠状窦（CS）几何形状。在 ICE 引导下进行无透视经间隔穿刺。使用可弯曲鞘管和多极导管呈现左心房（LA）和 PV 解剖结构，并在选择的情况下与三维 CT 图像整合。使用灌流射频消融环绕每对同侧 PV。
该系列包括 20 例连续 PAF 患者。RA/CS 标测需要 5.5 ± 2.6 分钟。所有患者均成功实现了单侧（n = 18）或双侧（n = 2）经间隔穿刺。使用圆形（14 例）或五边形（6 例）导管在 22 ± 10 分钟内呈现 LA-PV 解剖结构；11 例患者使用 CT 图像整合。使用 49 ± 18 个消融病变/患者，38/39 对同侧 PV 隔离病变集实现了电隔离（97%）。手术时间为 244 ± 75 分钟。无并发症。
使用 ICE 和 EAM 组合，完全无透视的阵发性 AF 导管消融是安全可行的。
