Kwong Wilson, Neilson Andrea L, Chiu Christine C, Gross Gil J, Hamilton Robert M, Soucie Luc, Stephenson Elizabeth A, Kirsh Joel A
Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
J Interv Card Electrophysiol. 2012 Jan;33(1):123-6. doi: 10.1007/s10840-011-9604-y. Epub 2011 Oct 18.
Catheter ablation is the established curative therapy for pediatric tachyarrhythmias. However, exposure to ionizing radiation from fluoroscopy during the procedure is of concern to both patients and caregivers. We sought to assess the impact of an impedance-based three-dimensional navigation system (NavX(TM), Endocardial Solutions, Inc., St. Paul, MN) on pediatric catheter ablation procedures.
We retrospectively analyzed procedural data during a 7-year period (2002-2008), which spanned the transition between standard fluoroscopic mapping and adoption of NavX(TM) mapping for catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) and right/left-sided accessory pathways (RAP/LAP). Comparisons of total procedure time, total fluoroscopy time, and ablation fluoroscopy time (from insertion of ablation catheter until completion of procedure) between NavX(TM) and conventional mapping were made.
Three hundred eighty-eight patients (aged 1-18 years, M/F 236:183) underwent ablation of AVNRT (n = 101), LAP (n = 130), or RAP (n = 157) using either conventional (n = 70) or NavX(TM) (n = 318) mapping. Overall success rates were similar between the two mapping approaches (95.7% for conventional versus 95.9% for NavX(TM)). NavX(TM) mapping significantly reduced ablation fluoroscopy time (15.9 ± 14.3 versus 11.0 ± 8.9 min for NavX(TM), p < 0.01) with a trend towards a decrease in total fluoroscopy time (26.4 ± 15.6 versus 23.8 ± 11.1 min for NavX(TM), p = 0.095). Total procedure time was not significantly different between the two methods (210.1 ± 66 versus 222.8 ± 61 min for NavX(TM), p = 0.13). When analyzed by arrhythmia substrate, there were significant reductions in ablation fluoroscopy time for both LAP and RAP.
NavX(TM) mapping reduced ablation fluoroscopy times for accessory pathways during pediatric catheter ablation.
导管消融是治疗小儿快速性心律失常的既定疗法。然而，在手术过程中暴露于荧光透视的电离辐射是患者和护理人员都关心的问题。我们试图评估基于阻抗的三维导航系统（NavX™，心内膜解决方案公司，明尼苏达州圣保罗）对小儿导管消融手术的影响。
我们回顾性分析了7年期间（2002 - 2008年）的手术数据，该时间段涵盖了从标准荧光透视标测到采用NavX™标测进行房室结折返性心动过速（AVNRT）以及右侧/左侧旁路（RAP/LAP）导管消融的转变过程。对NavX™和传统标测之间的总手术时间、总荧光透视时间以及消融荧光透视时间（从消融导管插入到手术完成）进行了比较。
388例患者（年龄1 - 18岁，男/女比例为236:183）使用传统标测（n = 70）或NavX™标测（n = 318）进行了AVNRT（n = 101）、LAP（n = 130）或RAP（n = 157）的消融。两种标测方法的总体成功率相似（传统标测为95.7%，NavX™标测为95.9%）。NavX™标测显著减少了消融荧光透视时间（NavX™为11.0±8.9分钟，传统标测为15.9±14.3分钟，p < 0.01），总荧光透视时间有减少趋势（NavX™为23.8±11.1分钟，传统标测为26.4±15.6分钟），p = 0.095）。两种方法的总手术时间无显著差异（NavX™为222.8±61分钟，传统标测为210.1±66分钟，p = 0.13）。按心律失常基质分析时，LAP和RAP的消融荧光透视时间均显著减少。
NavX™标测减少了小儿导管消融过程中旁路的消融荧光透视时间。
