Eberhard-Karls-Universität Tübingen, Tübingen, Germany.
Heart Rhythm. 2012 May;9(5):709-14. doi: 10.1016/j.hrthm.2011.12.025. Epub 2012 Jan 2.
Conventional catheter ablation of cardiac arrhythmias is associated with radiation risks for patients and laboratory personnel. However, nonfluoroscopic catheter guidance may increase the risk for inadvertent cardiac injury. A novel radiofrequency ablation catheter capable of real-time tissue-tip contact force measurements may compensate for nonfluoroscopic safety issues.
To investigate the feasibility of contact force-controlled zero-fluoroscopy catheter ablation.
In 30 patients (including 12 pediatric patients), zero-fluoroscopy catheter ablation of right-sided (right atrium, n = 20; right ventricle, n = 2) and left atrial (n = 8) arrhythmias was attempted. Inclusion criteria were symptomatic suspected atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, focal right atrial and ventricular arrhythmias, and lone atrial fibrillation. A novel irrigated-tip catheter with an integrated contact force sensor was used for nonfluoroscopic 3-dimensional electroanatomical mapping and radiofrequency ablation. Transseptal access was gained under transesophageal guidance for ablation of left-sided arrhythmias.
Procedural success without fluoroscopy was achieved in 29 of the 30 patients (97%). In 1 patient, endocardial nonfluoroscopic ablation failed because of an epicardial accessory pathway within a coronary sinus aneurysm. Mean total contact force and amplitude of force undulations were kept below 50 g during mapping and below 40 g during ablation to prevent contact force peaks (>100 g). Apart from a transient second-degree type I atrioventricular block, no complications occurred. The mean procedure time was 2.8 ± 0.9 hours. There were no arrhythmia recurrences during a mean follow-up of 6.2 ± 4.2 months.
Contact force-controlled zero-fluoroscopy catheter ablation is generally feasible in right-sided and left atrial cardiac arrhythmias.
传统的心导管消融术治疗心律失常会给患者和实验室人员带来辐射风险。然而，无荧光透视的导管引导可能会增加心脏意外损伤的风险。一种新型的能够实时测量组织尖端接触力的射频消融导管可能会弥补无荧光透视的安全问题。
探讨接触力控制的无荧光透视导管消融术的可行性。
在 30 例患者（包括 12 例儿科患者）中，尝试进行无荧光透视导管消融右心（右心房，n = 20；右心室，n = 2）和左心房（n = 8）心律失常。纳入标准为症状性疑似房室结折返性心动过速、房室折返性心动过速、局灶性右心房和心室心律失常以及孤立性心房颤动。一种新型的带有集成接触力传感器的灌流尖端导管用于无荧光 3 维电生理标测和射频消融。对于左心心律失常的消融，在经食管引导下经房间隔穿刺获得经皮心内通路。
30 例患者中有 29 例（97%）在无荧光透视的情况下获得了手术成功。在 1 例患者中，由于冠状窦瘤内的心外膜附加旁路，心内膜无荧光透视消融失败。在标测过程中，平均总接触力和力波动幅度保持在 50g 以下，在消融过程中保持在 40g 以下，以防止接触力峰值（>100g）。除一过性 2 度 1 型房室传导阻滞外，无其他并发症发生。平均手术时间为 2.8 ± 0.9 小时。平均随访 6.2 ± 4.2 个月期间，无心律失常复发。
接触力控制的无荧光透视导管消融术在右心和左心房心律失常中通常是可行的。
