Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom.
Circ Arrhythm Electrophysiol. 2012 Feb;5(1):131-9. doi: 10.1161/CIRCEP.111.962993. Epub 2011 Nov 7.
Improvement in outcome of infants born with congenital heart defects has been accompanied by an increasing frequency of late arrhythmias. Ablation is difficult because of multiple tachycardias in the presence of complex anatomy with limited accessibility. We report on remote-controlled ablation using magnetic navigation in conjunction with 3D image integration in patients with previous intra-atrial baffle procedures.
Thirteen patients (8 male; age, 30.5±8 years) with supraventricular tachycardia (SVT) underwent catheter ablation. Group A had a medical history of a Mustard or Senning operation, whereas group B had undergone total cavopulmonary connection. A total of 26 tachycardias were treated in 17 procedures (median cycle length of 280 ms). Group A patients had more inducible SVTs than group B, and all index SVTs were located in the remainder of the morphological right atrium in all but 1 patient. Retrograde access through the aorta was performed and led to successful ablation, using magnetic navigation with a very low total radiation exposure (median of 3.8 minutes in group A versus 5.9 minutes in group B). Only 1 of 13 patients continued to have short-lasting SVTs despite 3 ablation procedures during a median follow-up time of >200 days.
Remote-controlled catheter ablation by magnetic navigation in combination with accurate 3D image integration allowed safe and successful elimination of SVTs, using an exclusively retrograde approach, resulting in low radiation exposure for patients after intra-atrial baffle procedures (Mustard, Senning, or total cavopulmonary connection).
患有先天性心脏缺陷的婴儿的治疗效果得到改善，但随之而来的是晚期心律失常的发生率不断增加。由于存在复杂的解剖结构且可及性有限，因此存在多种心动过速，消融较为困难。我们报告了使用磁导航和 3D 图像融合技术对先前进行过房间隔旁路手术的患者进行远程控制消融的情况。
13 例（男 8 例；年龄 30.5±8 岁）患有室上性心动过速（SVT）的患者接受了导管消融治疗。A 组有 Mustard 或 Senning 手术史，而 B 组则接受了全腔静脉肺动脉连接术。17 次手术共治疗了 26 次心动过速（中位数心动过速周长为 280ms）。A 组患者可诱发出更多的 SVT，且所有的指数性 SVT 均位于除 1 例患者以外的其余右房形态学部位。通过主动脉逆行进入，使用磁导航进行了成功的消融，总辐射暴露量非常低（A 组中位数为 3.8 分钟，B 组中位数为 5.9 分钟）。在中位数超过 200 天的随访中，尽管有 3 次消融，但仍有 13 例患者中的 1 例出现短暂性 SVT。
使用磁导航和准确的 3D 图像融合进行远程控制导管消融，通过单纯逆行入路，可安全有效地消除房间隔旁路手术（Mustard、Senning 或全腔静脉肺动脉连接术）后患者的 SVT，且患者的辐射暴露量较低。
