Yokokawa Miki, Olgun Hilal, Sundaram Baskaran, Chugh Aman, Latchamsetty Rakesh, Good Eric, Crawford Thomas, Jongnarangsin Krit, Pelosi Frank, Bogun Frank, Morady Fred, Oral Hakan
Division of Cardiovascular Medicine, Cardiovascular Center, SPC 5853, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5853, USA.
J Interv Card Electrophysiol. 2012 Sep;34(3):255-62. doi: 10.1007/s10840-011-9660-3. Epub 2012 Feb 23.
This study aims to determine the impact of preprocedural imaging using computerized tomography (CT) or magnetic resonance imaging (MRI) with 3-D reconstruction on procedural efficiency, efficacy, complications and clinical outcome in patients who undergo radiofrequency catheter ablation (RFA) to eliminate atrial fibrillation (AF).
In this registry, a CT (n = 161) or MRI (n = 37) was obtained prior to RFA in 198 of 333 consecutive patients (age 61 ± 10 years) with paroxysmal (172) or persistent (161) AF. Antral pulmonary vein isolation was performed in all patients using an open-irrigation-tip catheter with a 3-D electroanatomical navigation system. Procedural and clinical outcomes were compared among patients who underwent RFA with and without preprocedural imaging.
The mean duration of the procedure (246 ± 47 vs. 242 ± 40 min, P = 0.55), fluoroscopy (47 ± 13 vs. 50 ± 10 min, P = 0.16), and total RF application (83 ± 27 vs. 78 ± 23 min, P = 0.17) were similar among patients who did and did not have preprocedural imaging. The likelihood of a complication also was similar (5/198 [3%] vs. 4/135 [3%], P = 1.0). A repeat ablation was performed in 95/198 (48%) and 61/135 (45%) of the patients who did and did not have imaging study, respectively (P = 0.62). At 22 ± 9 months, after a mean of 2 ± 1 procedures, 140/198 (71%) and 101/135 (75%) of the patients who did and did not have preprocedural imaging were in sinus rhythm (P = 0.4).
Preprocedural awareness of pulmonary venous and left atrial anatomy does not appear to have an effect on procedural efficiency or clinical outcomes in patients who undergo catheter ablation for AF.
本研究旨在确定在接受射频导管消融术（RFA）以消除心房颤动（AF）的患者中，使用计算机断层扫描（CT）或磁共振成像（MRI）及三维重建进行术前成像对手术效率、疗效、并发症及临床结局的影响。
在本登记研究中，333例连续的阵发性（172例）或持续性（161例）AF患者（年龄61±10岁）中的198例在RFA术前接受了CT（n = 161）或MRI（n = 37）检查。所有患者均使用带三维电解剖导航系统的开放式灌注尖端导管进行肺静脉前庭隔离术。对接受和未接受术前成像的RFA患者的手术及临床结局进行比较。
接受和未接受术前成像的患者之间，手术平均持续时间（246±47 vs. 242±40分钟，P = 0.55）、透视时间（47±13 vs. 50±10分钟，P = 0.16）及总射频应用时间（83±27 vs. 78±23分钟，P = 0.17）相似。并发症发生可能性也相似（198例中的5例[3%] vs. 135例中的4例[3%]，P = 1.0）。接受和未接受成像检查的患者中，分别有95/198（48%）和61/135（45%）进行了再次消融（P = 0.62）。在平均2±1次手术后的22±9个月时，接受和未接受术前成像的患者中分别有140/198（71%）和101/135（75%）处于窦性心律（P = 0.4）。
对于接受AF导管消融术的患者，术前了解肺静脉和左心房解剖结构似乎对手术效率或临床结局没有影响。
