Chen Jian, Hoff Per Ivar, Solheim Eivind, Schuster Peter, Off Morten Kristian, Ohm Ole-Jørgen
Hjerteavdelingen, Haukeland universitetssykehus, 5021 Bergen, Norway.
Tidsskr Nor Laegeforen. 2010 Aug 12;130(15):1467-70. doi: 10.4045/tidsskr.09.0249.
The first use of magnetic navigation for radiofrequency ablation of supraventricular tachycardias, was published in 2004. Subsequently, the method has been used for treatment of most types of tachyarrhythmias. This paper provides an overview of the method, with special emphasis on usefulness of a new remote-controlled magnetic navigation system.
The paper is based on our own scientific experience and literature identified through a non-systematic search in PubMed.
The magnetic navigation system consists of two external electromagnets (to be placed on opposite sides of the patient), which guide an ablation catheter (with a small magnet at the tip of the catheter) to the target area in the heart. The accuracy of this procedure is higher than that with manual navigation. Personnel can be quickly trained to use remote magnetic navigation, but the procedure itself is time-consuming, particularly for patients with atrial fibrillation. The major advantage is a considerably lower radiation burden to both patient and operator, in some studies more than 50 %, and a corresponding reduction in physical strain on the operator. The incidence of procedure-related complications seems to be lower than that observed with use of manually operated ablation catheters. Work is ongoing to improve magnetic ablation catheters and methods that can simplify mapping procedures and improve efficacy of arrhythmia ablation. The basic cost for installing a complete magnetic navigation laboratory may be three times that of a conventional electrophysiological laboratory.
The new magnetic navigation system has proved to be applicable during ablation for a variety of tachyarrhythmias, but is still under development.
2004年首次发表了关于使用磁导航进行室上性心动过速射频消融的研究。随后，该方法已被用于治疗大多数类型的快速性心律失常。本文概述了该方法，特别强调了一种新型遥控磁导航系统的实用性。
本文基于我们自己的科学经验以及通过在PubMed中进行非系统检索所确定的文献。
磁导航系统由两个外部电磁铁（放置在患者身体两侧）组成，它们将一根消融导管（导管尖端带有一个小磁铁）引导至心脏的目标区域。该操作的准确性高于手动导航。人员能够快速接受培训以使用遥控磁导航，但操作过程本身耗时较长，尤其是对于房颤患者。主要优点是患者和操作者所承受的辐射负担显著降低，在一些研究中超过50%，并且操作者的身体劳损相应减少。与操作相关的并发症发生率似乎低于使用手动操作消融导管时观察到的发生率。目前正在努力改进磁消融导管以及能够简化标测程序并提高心律失常消融疗效的方法。安装一个完整磁导航实验室的基本成本可能是传统电生理实验室的三倍。
新型磁导航系统已被证明可用于多种快速性心律失常的消融，但仍在不断发展中。
