Christoph Marian, Wunderlich Carsten, Moebius Stefanie, Forkmann Mathias, Sitzy Judith, Salmas Jozef, Mayer Julia, Huo Yan, Piorkowski Christopher, Gaspar Thomas
Department of Electrophysiology, Heart Center Dresden, University of Dresden, University of Technology Dresden, Fetscherstrasse 76, Dresden 01307, Germany
Department of Electrophysiology, Heart Center Dresden, University of Dresden, University of Technology Dresden, Fetscherstrasse 76, Dresden 01307, Germany.
Europace. 2015 Jun;17(6):928-37. doi: 10.1093/europace/euu334. Epub 2015 Jan 21.
Despite the use of established 3D-mapping systems, invasive electrophysiological studies and catheter ablation require high radiation exposure of patients and medical staff. This study investigated whether electroanatomic catheter tracking in prerecorded X-ray images on top of an existing 3D-mapping system has any impact on radiation exposure.
Two hundred and ninety-five consecutive patients were either ablated with the guidance of the traditional CARTO-3 system (c3) or with help of the CARTO-UNIVU system (cU): [typical atrial flutter (AFL) n = 58, drug refractory atrial fibrillation (AF) n = 81, ectopic atrial tachycardia (EAT) n = 37, accessory pathways (APs) n = 22, symptomatic, idiopathic premature ventricular complexes (PVCs) n = 56, ventricular tachycardias (VTs) n = 41]. The CARTO-UNIVU allowed a reduction in radiation exposure: fluoroscopy time: AFL c3: 8.6 ± 0.8 min vs. cU: 2.9 ± 0.3 min, P < 0.001; AF c3: 16.0 ± 1.3 min vs. cU: 6.4 ± 0.9 min, P < 0.001; EAT c3: 23.4 ± 3.1 min vs. cU: 9.7 ± 1.7 min, P < 0.001; AP c3: 7.1 ± 1.2 min vs. cU: 6.0 ± 1.5 min, P = 0.59; PVCs c3: 17.6 ± 2.3 min vs. cU: 15.2 ± 2.8 min, P = 0.52; VT c3: 31.4 ± 3.4 min vs. cU: 17.5 ± 2.4 min, P = 0.003. Corresponding to the fluoroscopy time the fluoroscopy dose was also reduced significantly. These advantages were not at the cost of increased procedure times, periprocedural complications, or decreased acute ablation success rates.
In a wide spectrum of cardiac arrhythmias, and especially in AF and VT ablation, fluoroscopy integrated 3D mapping contributed to a dramatic reduction in radiation exposure without prolonging procedure times and compromising patient's safety. That effect, however, could not be maintained in patients with APs and PVCs.
尽管使用了成熟的三维标测系统，但侵入性电生理研究和导管消融术会使患者和医护人员受到高剂量辐射。本研究调查了在现有三维标测系统之上利用预先录制的X线影像进行电解剖导管追踪是否会对辐射暴露产生影响。
连续纳入295例患者，分别在传统CARTO-3系统（c3）或CARTO-UNIVU系统（cU）的辅助下进行消融：[典型房扑（AFL）58例、药物难治性房颤（AF）81例、异位房性心动过速（EAT）37例、旁路（AP）22例、有症状的特发性室性早搏（PVC）56例、室性心动过速（VT）41例]。CARTO-UNIVU系统可减少辐射暴露：透视时间：AFL，c3组：8.6±0.8分钟，cU组：2.9±0.3分钟，P<0.001；AF，c3组：16.0±1.3分钟，cU组：6.4±0.9分钟，P<0.001；EAT，c3组：23.4±3.1分钟，cU组：9.7±1.7分钟，P<0.001；AP，c3组：7.1±1.2分钟，cU组：6.0±1.5分钟，P=0.59；PVC，c3组：17.6±2.3分钟，cU组：15.2±2.8分钟，P=0.52；VT，c3组：31.4±3.4分钟，cU组：17.5±2.4分钟，P=0.003。与透视时间相应，透视剂量也显著降低。这些优势并未以增加手术时间、围手术期并发症或降低急性消融成功率为代价。
在多种心律失常中，尤其是在房颤和室性心动过速消融中，透视集成三维标测有助于显著降低辐射暴露，且不延长手术时间，不危及患者安全。然而，对于旁路和室性早搏患者，这种效果无法维持。
