Fernández-Gómez Juan M, Moriña-Vázquez Pablo, Morales Elena Del Rio, Venegas-Gamero José, Barba-Pichardo Rafael, Carranza Manuel Herrera
Arrhythmia and Pacing Unit, Hospital Juan Ramón Jimenez, Huelva, Spain.
J Cardiovasc Electrophysiol. 2014 Jun;25(6):638-44. doi: 10.1111/jce.12385. Epub 2014 Mar 10.
Nonfluoroscopic mapping systems have demonstrated significant reduction of radiation exposure in radiofrequency (RF) catheter ablation procedures. However, their use as only imaging guide is still limited.
To evaluate the usefulness of a completely nonfluoroscopic approach to catheter ablation of supraventricular arrhythmias using the Ensite-NavX™ electroanatomical navigation system.
During 6 years, all consecutive patients referred for RF catheter ablation of regular supraventricular tachycardia (SVT) were admitted for a "zero-fluoroscopy" approach and studied prospectively. The only exclusion criterion was the need to perform a transseptal puncture.
A total of 340 procedures were performed on 328 patients (179 men, age 55.7 ± 18.6 years). One hundred fifty-three patients had typical atrial flutter (AFL), 146 had AV nodal reentrant tachycardia (AVNRT), 35 had AV reciprocating tachycardia (AVRT), 4 patients had incisional atrial flutter (IAF), and 2 had focal atrial tachycardia (AT). Procedural success was achieved in 337 of the cases (99.1%). In 322 (94.7%), the procedure was completed without any fluoroscopy use. Mean procedure time was 110.5 ± 51.8 minutes. Mean RF application time was 9.8 ± 12.8 minutes and the number of RF lesions was 16.43 ± 15.8. Only 1 major complication related to vascular access was recorded. During follow-up, there were 12 recurrences (3.5%) (8 patients from the AVNRT group, 4 patients from the AP group).
RF catheter ablation of SVT with an approach completely guided by the NavX system and without use of fluoroscopy is feasible, safe, and effective.
非荧光透视标测系统已证实在射频（RF）导管消融术中可显著减少辐射暴露。然而，其仅作为成像引导的应用仍有限。
使用Ensite-NavX™ 电解剖导航系统评估完全非荧光透视方法用于室上性心律失常导管消融的有效性。
在6年期间，所有因常规室上性心动过速（SVT）接受RF导管消融的连续患者均采用“零荧光透视”方法入院并进行前瞻性研究。唯一的排除标准是需要进行经房间隔穿刺。
共对328例患者（179例男性，年龄55.7±18.6岁）进行了340例手术。153例患者患有典型心房扑动（AFL），146例患有房室结折返性心动过速（AVNRT），35例患有房室折返性心动过速（AVRT），4例患有切口性心房扑动（IAF），2例患有局灶性房性心动过速（AT）。337例（99.1%）手术获得成功。322例（94.7%）手术在未使用任何荧光透视的情况下完成。平均手术时间为110.5±51.8分钟。平均RF应用时间为9.8±12.8分钟，RF消融灶数量为16.43±15.8个。仅记录到1例与血管通路相关的严重并发症。随访期间，有12例复发（3.5%）（AVNRT组8例患者，AP组4例患者）。
采用完全由NavX系统引导且不使用荧光透视的方法进行SVT的RF导管消融是可行、安全且有效的。
