Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany.
Europace. 2015 Jul;17(7):1117-21. doi: 10.1093/europace/euu398. Epub 2015 Mar 3.
Reduction of radiation exposure using a sensor-based non-fluoroscopic catheter tracking (NFCT) system (MediGuide™, St Jude Medical, Inc.) was recently demonstrated by retrospective comparisons. We aimed to prospectively compare the effects of using NFCT vs. standard fluoroscopy on procedural parameters in patients undergoing radiofrequency ablation of typical atrial flutter.
We prospectively randomized 40 patients undergoing cavotricuspid isthmus ablation for typical atrial flutter to either NFCT (n = 20) or conventional fluoroscopy (CONV, n = 20). Procedural parameters such as fluoroscopy time, radiation dose, and procedure duration, as well as periprocedural complications were compared. There were no statistically significant differences in baseline characteristics between the two groups. Bidirectional isthmus block was achieved in all patients. Fluoroscopy time was significantly reduced in the NFCT group {0.3 [inter-quartile range (IQR) 0.2; 0.48] min} when compared with CONV [5.7 (IQR 4.2; 11.5) min] (P < 0.001). This resulted in a significant reduction in radiation dose in patients randomized to NFCT [17.4 (IQR 11; 206.6) cGy cm(2)] vs. the CONV group [418.4 (IQR 277; 812.2) cGy cm(2)] (P < 0.001). There were no significant differences in procedure duration between the NFCT group [49.5 (IQR 37; 65) min] when compared with the CONV group [33.5 (IQR 26.3; 55.5) min] (P = 0.053). No adverse events were recorded. Freedom from atrial flutter at 6 months of follow-up was 19/20 (95%) in the NFCT and 18/20 (90%) in the CONV group (n.s.).
In this first prospective randomized study, by comparing NFCT with standard fluoroscopy in patients undergoing radiofrequency ablation of typical atrial flutter, NFCT significantly reduced both radiation dose and fluoroscopy time with no effects on procedural duration. These findings support the incorporation of NFCT in routine clinical use.
使用基于传感器的非透视导管跟踪（NFCT）系统（MediGuide™，St Jude Medical，Inc.）可降低辐射暴露量，最近通过回顾性比较得到了证实。我们旨在前瞻性比较在接受射频消融治疗典型心房扑动的患者中，使用 NFCT 与标准透视术对程序参数的影响。
我们前瞻性地将 40 名接受典型心房扑动的三尖瓣峡部消融术的患者随机分为 NFCT 组（n=20）或常规透视组（CONV，n=20）。比较了透视时间、辐射剂量和手术持续时间等程序参数以及围手术期并发症。两组患者的基线特征无统计学差异。所有患者均实现了双向峡部阻滞。与 CONV 组[5.7（四分位距 4.2；11.5）min]相比，NFCT 组的透视时间明显减少{0.3（四分位距 0.2；0.48）min}（P<0.001）。这导致 NFCT 组的辐射剂量显著降低[17.4（四分位距 11；206.6）cGy cm（2）]与 CONV 组[418.4（四分位距 277；812.2）cGy cm（2）]相比（P<0.001）。NFCT 组的手术持续时间[49.5（四分位距 37；65）min]与 CONV 组[33.5（四分位距 26.3；55.5）min]相比无显著差异（P=0.053）。无不良事件记录。6 个月随访时，NFCT 组有 19/20（95%）例患者和 CONV 组有 18/20（90%）例患者无心房扑动（无统计学差异）。
在这项比较射频消融治疗典型心房扑动患者中 NFCT 与标准透视术的首次前瞻性随机研究中，NFCT 显著降低了辐射剂量和透视时间，而对手术持续时间没有影响。这些发现支持将 NFCT 纳入常规临床使用。
