Pillarisetti Jayasree, Kanmanthareddy Arun, Reddy Yeruva Madhu, Lakkireddy Dhanunjaya
Division of Cardiology, University of Kansas Hospital, Kansas City, KS, USA.
J Interv Card Electrophysiol. 2014 Sep;40(3):221-7. doi: 10.1007/s10840-014-9909-8. Epub 2014 Jun 14.
Since the introduction of percutaneous intervention in modern medical science, specifically cardiovascular medicine fluoroscopy has remained the gold standard for navigation inside the cardiac structures. As the complexity of the procedures continue to increase with advances in interventional electrophysiology, the procedural times and fluoroscopy times have proportionately increased and the risks of radiation exposure both to the patients as well as the operator continue to rise. 3D electroanatomic mapping systems have to some extent complemented fluoroscopic imaging in improving catheter navigation and forming a solid platform for exploring the electroanatomic details of the target substrate. The 3D mapping systems are still limited as they continue to be static representations of a dynamic heart without being completely integrated with fluoroscopy. The field needed a technological solution that could add a dynamic positioning system that can be successfully incorporated into fluoroscopic imaging as well as electroanatomic imaging modalities. MediGuide is one such innovative technology that exploits the geo-positioning system principles. It employs a transmitter mounted on the X-ray panel that emits an electromagnetic field within which sensor-equipped diagnostic and ablation catheters are tracked within prerecorded fluoroscopic images. MediGuide is also integrated with NavX mapping system and helps in developing better 3D images by field scaling-a process that reduces field distortions that occur from impedance mapping alone. In this review, we discuss about the principle of MediGuide technology, the catheter ablation techniques, and the workflow in the EP lab for different procedures.
自从经皮介入技术引入现代医学科学以来，尤其是在心血管医学领域，荧光透视法一直是心脏结构内部导航的金标准。随着介入电生理学的发展，手术的复杂性不断增加，手术时间和荧光透视时间相应延长，患者和操作人员所受辐射暴露风险持续上升。三维电解剖标测系统在一定程度上补充了荧光透视成像，有助于改善导管导航，并为探索目标基质的电解剖细节搭建了坚实的平台。然而，三维标测系统仍存在局限性，因为它们仍然是动态心脏的静态呈现，无法与荧光透视法完全整合。该领域需要一种技术解决方案，能够添加一个动态定位系统，并成功整合到荧光透视成像和电解剖成像模式中。MediGuide就是这样一种利用地理定位系统原理的创新技术。它在X射线面板上安装了一个发射器，该发射器发射一个电磁场，在此电磁场中，配备传感器的诊断和消融导管可在预先录制的荧光透视图像中被追踪。MediGuide还与NavX标测系统集成，通过场缩放（一种减少仅由阻抗标测产生的场失真的过程）来帮助生成更好的三维图像。在这篇综述中，我们讨论了MediGuide技术的原理、导管消融技术以及不同手术在电生理实验室中的工作流程。
