Matsubara Takumi J, Fujiu Katsuhito, Asada Kazuo, Kojima Toshiya, Hisaki Makimoto, Yamagata Kenichiro, Shimizu Yu, Hasumi Eriko, Masaru Hatano, Akazawa Hiroshi, Komuro Issei
Department of Cardiovascular Medicine, The University of Tokyo, Japan.
Department of Cardiovascular Medicine, The University of Tokyo, Japan; Department of Ubiquitous Health Informatics, The University of Tokyo, Japan.
Int J Cardiol. 2016 Jan 15;203:733-9. doi: 10.1016/j.ijcard.2015.11.038. Epub 2015 Nov 6.
Preoperative and intraoperative use of a contrast medium is unavoidable in catheter ablation for atrial fibrillation, which can become a particularly significant issue for patients suffering from renal impairment.
The purpose of this study is to investigate the feasibility and safety of a technique for atrial fibrillation ablation without a contrast medium via intra-cardiac ultrasound imaging only.
We prepared the geometry of the pulmonary vein and left atrium via a SOUNDSTAR catheter from inside the left atrium, without preoperative and intraoperative investigations using contrast mediums, for computed tomography or magnetic resonance imaging and pulmonary venography. This was followed by retrospective investigation of the success rate and complications observed in 200 successive paroxysmal and persistent atrial fibrillation cases that underwent catheter ablation from January 2011 to November 2012. The outcomes were assessed after the one-year follow-up.
Inserting a SOUNDSTAR catheter into the left atrium was successful in all cases, wherein rendering of all pulmonary veins and the left atrium was possible, and extensive encircling pulmonary vein isolation was successful in all cases. The sinus rhythm maintenance rate one year after the procedure was 90.4% for paroxysmal atrial fibrillation and 76.0% for persistent atrial fibrillation. The major complication rate was 0.5% (cardiac tamponade), with no cases presenting aggravation of renal function.
Atrial fibrillation ablation using an intra-cardiac ultrasound from the left atrium without employing a contrast medium was safe, with no adverse effects on renal function.
在心房颤动导管消融术中，术前和术中使用造影剂是不可避免的，而这对于肾功能不全的患者可能会成为一个尤为重要的问题。
本研究旨在探讨仅通过心腔内超声成像进行无造影剂心房颤动消融技术的可行性和安全性。
我们通过SOUNDSTAR导管从左心房内部构建肺静脉和左心房的几何形状，无需术前和术中使用造影剂进行计算机断层扫描、磁共振成像或肺静脉造影检查。随后，对2011年1月至2012年11月期间连续200例接受导管消融的阵发性和持续性心房颤动患者的成功率和并发症进行回顾性研究。在一年随访后评估结果。
所有病例均成功将SOUNDSTAR导管插入左心房，所有肺静脉和左心房均能成像，所有病例广泛环绕肺静脉隔离均成功。术后一年阵发性心房颤动的窦性心律维持率为90.4%，持续性心房颤动为76.0%。主要并发症发生率为0.5%（心脏压塞），无肾功能恶化病例。
仅通过左心房的心腔内超声进行心房颤动消融是安全的，对肾功能无不良影响。
