Bhatia Nisha L, Jahangir Arshad, Pavlicek William, Scott Luis R P, Altemose Gregory T, Srivathsan Komandoor
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Scottsdale, AZ, USA.
Department of Radiology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA.
J Atr Fibrillation. 2010 Dec 15;3(4):280. doi: 10.4022/jafib.280. eCollection 2010 Dec.
Radiation exposure with cardiac interventional procedures is an emerging concern. Patients receiving radiofrequency ablation for atrial fibrillation (AF) still routinely undergo pre-ablation computed tomography (CT) scans for definition of left atrial and pulmonary vein anatomy, as well as creation of a surrogate geometry. In an effort to decrease ionizing radiation associated with AF ablation, an ultrasound-guided surrogate geometry approach is proposed as an alternative to routine CT imaging. Ten patients underwent AF ablation using intracardiac ultrasound for the creation of a surrogate left atrial geometry (CartoSound, Biosense Webster, CA); and ten control-cases who had conventional CT-guided imaging (CartoMerge, Biosense Webster, CA) were matched for age, gender, and type of catheter ablation. Sources of radiation included 1) intraprocedural fluoroscopy (CartoSound: 151 ± 43 mGraycm^2, CartoMerge: 174 ± 130 mGraycm^2; p=0.6) and 2) CT ionizing radiation (CartoSound: 0 mSv, CartoMerge 9.4 ± 2.3 mSv/CT scan.) When comparing clinical success rates after a trial of previously ineffective anti-arrhythmic drugs, ultrasound-guided AF ablation was non-inferior to a CT-guided approach. This potentially obviates the need for CT-guided imaging, therefore reducing doses of ionizing radiation by nearly 10 mSv per AF catheter ablation.
心脏介入手术中的辐射暴露是一个新出现的问题。接受房颤（AF）射频消融术的患者仍常规进行消融术前计算机断层扫描（CT），以明确左心房和肺静脉解剖结构，并创建替代几何模型。为了减少与房颤消融相关的电离辐射，有人提出采用超声引导的替代几何模型方法作为常规CT成像的替代方案。10例患者使用心内超声创建替代左心房几何模型（CartoSound，Biosense Webster，加利福尼亚州）进行房颤消融；另外10例采用传统CT引导成像（CartoMerge，Biosense Webster，加利福尼亚州）的对照病例在年龄、性别和导管消融类型方面进行了匹配。辐射源包括：1）术中透视（CartoSound：151±43毫戈瑞·平方厘米，CartoMerge：174±130毫戈瑞·平方厘米；p=0.6）和2）CT电离辐射（CartoSound：0毫希沃特，CartoMerge：9.4±2.3毫希沃特/CT扫描）。在对先前无效的抗心律失常药物试验后的临床成功率进行比较时，超声引导的房颤消融术不劣于CT引导的方法。这可能无需CT引导成像，从而使每次房颤导管消融的电离辐射剂量减少近10毫希沃特。
