Casella Michela, Pelargonio Gemma, Dello Russo Antonio, Riva Stefania, Bartoletti Stefano, Santangeli Pasquale, Scarà Antonio, Sanna Tommaso, Proietti Riccardo, Di Biase Luigi, Gallinghouse G Joseph, Narducci Maria Lucia, Sisto Luigi, Bellocci Fulvio, Natale Andrea, Tondo Claudio
Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
J Interv Card Electrophysiol. 2011 Aug;31(2):109-18. doi: 10.1007/s10840-011-9553-5. Epub 2011 Mar 2.
Radiofrequency catheter ablation (RFCA) of supraventricular tachyarrhythmias carries a small but non-negligible radiation risk. Studies in children already showed the feasibility of using three-dimensional mapping systems as the primary guide for catheter visualization and positioning in these RFCAs. We aim to demonstrate the feasibility and safety of such an approach in young and middle-aged patients.
Fifty patients (age 34 ± 12) with supraventricular tachyarrhythmias underwent electrophysiological study; of these, 47 patients proceeded to RFCA guided by the EnSite NavX(TM) system (23 with atrioventricular nodal reentry tachycardia, 16 with an accessory pathway, six with typical atrial flutter, and two with right atrial tachycardia).
In 38/50 cases (76%), electroanatomical mapping avoided fluoroscopy entirely, including four cases requiring access to the left heart chambers by a retrograde approach. In the remaining 12/50 cases (24%), fluoroscopy use was limited to 122 ± 80 s, with a correspondingly low radiation exposure (dose area product 1.3 ± 1.1 mGy × m(2)). All procedures were acutely successful, with a procedural time of 113 ± 37 minutes, and without incurring in any major complication. Over a mean follow-up of 12 ± 3 months, we observed one recurrence of pre-excitation and one relapse of atrial flutter.
Our study shows that non-fluoroscopic RFCA of supraventricular tachyarrhythmias using the EnSite NavX(TM) system is feasible, safe, and effective in a population of relatively young adults. Our experience of a non-fluoroscopic approach in these procedures deserves consideration, particularly in the young or in other patients at higher radiation risk.
室上性快速心律失常的射频导管消融（RFCA）存在小但不可忽视的辐射风险。针对儿童的研究已表明，在这些RFCA中使用三维标测系统作为导管可视化和定位的主要引导具有可行性。我们旨在证明这种方法在中青年患者中的可行性和安全性。
50例（年龄34±12岁）室上性快速心律失常患者接受了电生理研究；其中，47例患者在EnSite NavX™系统引导下进行RFCA（23例为房室结折返性心动过速，16例为旁路，6例为典型心房扑动，2例为右房心动过速）。
在50例中的38例（76%）中，电解剖标测完全避免了使用荧光透视，包括4例需要逆行途径进入左心腔的病例。在其余12/50例（24%）中，荧光透视的使用时间限制在122±80秒，辐射暴露相应较低（剂量面积乘积为1.3±1.1 mGy×m²）。所有手术均即刻成功，手术时间为113±37分钟，且未发生任何重大并发症。在平均12±3个月的随访中，我们观察到1例预激复发和1例心房扑动复发。
我们的研究表明，使用EnSite NavX™系统对室上性快速心律失常进行非荧光透视RFCA在相对年轻的成年人群中是可行、安全且有效的。我们在这些手术中采用非荧光透视方法的经验值得考虑，特别是在年轻人或其他辐射风险较高的患者中。
