Adragão Pedro Pulido, Cavaco Diogo, Ferreira António Miguel, Costa Francisco Moscoso, Parreira Leonor, Carmo Pedro, Morgado Francisco Bello, Santos Katya Reis, Santos Pedro Galvão, Carvalho Maria Salomé, Durazzo Anai, Marques Hugo, Gonçalves Pedro Araújo, Raposo Luís, Mendes Miguel
Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.
Cardiology Department, Hospital da Luz, Lisbon, Portugal.
J Cardiovasc Electrophysiol. 2016 Mar;27 Suppl 1:S11-6. doi: 10.1111/jce.12900.
Whether or not the potential advantages of using a magnetic navigation system (MNS) translate into improved outcomes in patients undergoing atrial fibrillation (AF) ablation is a question that remains unanswered.
In this observational registry study, we used propensity-score matching to compare the outcomes of patients with symptomatic drug-refractory AF who underwent catheter ablation using MNS with the outcomes of those who underwent catheter ablation using conventional manual navigation. Among 1,035 eligible patients, 287 patients in each group had similar propensity scores and were included in the analysis. The primary efficacy outcome was the rate of AF relapse after a 3-month blanking period. At a mean follow-up of 2.6 ± 1.5 years, AF ablation with MNS was associated with a similar risk of AF relapse as compared with manual navigation (18.4% per year and 22.3% per year, respectively; hazard ratio 0.81, 95% CI 0.63-1.05; P = 0.108). Major complications occurred in two patients (0.7%) using MNS, and in six patients (2.1%) undergoing manually navigated ablation (P = 0.286). Fluoroscopy times were 21 ± 10 minutes in the manual navigation group, and 12 ± 9 minutes in the MNS group (P < 0.001), whereas total procedure times were 152 ± 52 minutes and 213 ± 58 minutes, respectively (P < 0.001).
In this propensity-score matched comparison, magnetic navigation and conventional manual AF ablations seem to have similar relapse rates and a similar risk of complications. AF ablations with magnetic navigation take longer to perform but expose patients to significantly shorter fluoroscopy times.
使用磁导航系统（MNS）的潜在优势能否转化为改善房颤（AF）消融患者的治疗效果，这一问题仍未得到解答。
在这项观察性注册研究中，我们使用倾向评分匹配法，比较了有症状的药物难治性AF患者接受MNS导管消融与接受传统手动导航导管消融的治疗效果。在1035例符合条件的患者中，每组287例患者具有相似的倾向评分，并纳入分析。主要疗效指标是3个月空白期后的房颤复发率。平均随访2.6±1.5年，与手动导航相比，MNS房颤消融的房颤复发风险相似（分别为每年18.4%和22.3%；风险比0.81，95%CI 0.63 - 1.05；P = 0.108）。使用MNS的两名患者（0.7%）和接受手动导航消融的六名患者（2.1%）发生了主要并发症（P = 0.286）。手动导航组的透视时间为21±10分钟，MNS组为12±9分钟（P < 0.001），而总手术时间分别为152±52分钟和213±58分钟（P < 0.001）。
在这项倾向评分匹配比较中，磁导航和传统手动房颤消融似乎具有相似的复发率和并发症风险。磁导航房颤消融手术时间较长，但患者接受透视的时间明显较短。
