Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
Heart Rhythm. 2013 Sep;10(9):1293-300. doi: 10.1016/j.hrthm.2013.05.008. Epub 2013 May 14.
The MediGuide technology (MGT) represents a novel sensor-based electromagnetic 4-dimensional (4D) navigation system allowing real-time catheter tracking in the environment of prerecorded X-ray loops.
To report on our clinical experience in atrial fibrillation (AF) ablation with recently available MGT-enabled ablation catheters.
The MGT was used in addition to a conventional 3D mapping system in 80 patients with AF (age 61 ± 10 years; 47 men; 40 with persistent AF), who underwent circumferential pulmonary vein isolation and voltage mapping with and without substrate modification. Short native right anterior oblique/left anterior oblique loops were used as background movies for the nonfluoroscopic placement of sensor-equipped diagnostic catheters into the coronary sinus and the right ventricle. After single transseptal puncture, selective angiograms of the pulmonary veins were used as background movies for near nonfluoroscopic left atrial reconstruction. Computed tomography registration as well as mapping/ablation was performed by using the new open-irrigated MGT-enabled ablation catheter.
MGT application was not associated with a change in established workflow. Large parts of the procedure (mean entire duration 167 ± 47 minutes) could be done without additional fluoroscopy, whereas median residual fluoroscopy duration of 4.6 (interquartile range: 2.9, 7.1) minutes was mainly used for the acquisition of background loops, transseptal puncture, occasional verification of transseptal sheath position, and manipulation of the circular mapping catheter. Three (4%) minor complications occurred.
The MGT integrates easily into the workflow of standard AF ablation and allows for high-quality nonfluoroscopic 4D catheter tracking. This results in low radiation exposure for patients and staff without complicating the workflow of the procedure.
MediGuide 技术（MGT）是一种新型基于传感器的电磁四维（4D）导航系统，可在预录 X 射线环的环境中实时跟踪导管。
报告我们使用最近可用的配备 MGT 的消融导管进行心房颤动（AF）消融的临床经验。
在 80 例 AF 患者（年龄 61 ± 10 岁；47 名男性；40 例持续性 AF）中，除了常规 3D 映射系统外，还使用了 MGT，这些患者接受了环形肺静脉隔离和电压映射，同时进行了和不进行基质改性。使用短的原生右前斜位/左前斜位环作为背景电影，将带有传感器的诊断导管非透视放置到冠状窦和右心室中。进行单次经房间隔穿刺后，使用肺动脉选择性血管造影作为背景电影，进行近非透视左心房重建。使用新的开放灌洗式配备 MGT 的消融导管进行 CT 配准以及映射/消融。
MGT 应用与既定工作流程的改变无关。大部分程序（平均总持续时间 167 ± 47 分钟）可以在没有额外透视的情况下完成，而中位数透视持续时间为 4.6（四分位距：2.9，7.1）分钟主要用于获取背景环、经房间隔穿刺、偶尔验证经房间隔鞘位置和操作环形标测导管。发生了 3 例（4%）轻微并发症。
MGT 很容易集成到标准 AF 消融的工作流程中，并允许进行高质量的非透视 4D 导管跟踪。这使得患者和工作人员的辐射暴露量降低，而不会使手术流程复杂化。
