Lim Paul Chun Yih, Toh Joseph Jia Hong, Loh Julian Kenrick Xing Yuan, Lee Edward Chun Yi, Chong Daniel Thuan Tee, Tan Boon Yew, Ho Kah Leng, Ching Chi Keong, Teo Wee Siong
Department of Cardiology, National Heart Centre Singapore, Singapore.
J Arrhythm. 2017 Jun;33(3):167-171. doi: 10.1016/j.joa.2016.08.007. Epub 2016 Nov 10.
Percutaneous transcatheter radiofrequency ablation of atrial fibrillation with remote controlled magnetic navigation (RMN) has been shown to reduce radiation exposure to patients and physicians compared with conventional manual (MAN) ablation techniques.
Catheter ablation for atrial fibrillation was performed utilizing RMN in 214 consecutive patients and MAN ablation techniques in 229 patients. We compared the fluoroscopy and procedural times between RMN and MAN catheter ablation of atrial fibrillation. Secondary objectives included comparing acute procedural success and short-term complication rates between both ablation strategies.
Fluoroscopy time was significantly shorter in the RMN group than the MAN group (53.5±30.1 vs 68.1±27.6 min, respectively; <0.01); however, the total procedural time was longer in the RMN group (280.2±74.4 min vs 213.1±64.75, respectively; >0.001). Further subgroup analysis of the most recent 50 ablations each from the RMN and MAN groups, to attenuate the RMN learning curve effect, showed an even greater difference in fluoroscopy time (RMN vs MAN: 53.5±30.1 vs 68.1±27.6 min), though a consistently longer procedure time with RMN (249.5±65.5 vs 186.3±65.6 min, respectively). The acute procedural success rate was comparable between the groups (98.6% vs 95.6%, respectively; =0.07). The rates of acute complications were similar in both groups (2.3% vs 4.8%, respectively; =0.16).
In radiofrequency ablation of atrial fibrillation, RMN appears to significantly reduce fluoroscopy time compared with conventional MAN ablation, though at a cost of increased total procedural time, with comparable acute success rates and safety profile. A reduction in procedure and fluoroscopy times is possible with gaining experience.
与传统手动（MAN）消融技术相比，经皮导管射频消融联合遥控磁导航（RMN）治疗心房颤动已被证明可减少患者和医生的辐射暴露。
对214例连续患者采用RMN进行心房颤动导管消融，对229例患者采用MAN消融技术。我们比较了RMN和MAN导管消融心房颤动的透视时间和手术时间。次要目标包括比较两种消融策略的急性手术成功率和短期并发症发生率。
RMN组的透视时间明显短于MAN组（分别为53.5±30.1分钟和68.1±27.6分钟；<0.01）；然而，RMN组的总手术时间更长（分别为280.2±74.4分钟和213.1±64.75分钟；>0.001）。对RMN组和MAN组最近各50例消融进行进一步亚组分析，以减弱RMN学习曲线效应，结果显示透视时间差异更大（RMN组与MAN组：53.5±30.1分钟和68.1±27.6分钟），尽管RMN的手术时间始终更长（分别为249.5±65.5分钟和186.3±65.6分钟）。两组的急性手术成功率相当（分别为98.6%和95.6%；=0.07）。两组的急性并发症发生率相似（分别为2.3%和4.8%；=0.16）。
在心房颤动的射频消融中，与传统MAN消融相比，RMN似乎能显著减少透视时间，尽管代价是总手术时间增加，急性成功率和安全性相当。随着经验的积累，手术时间和透视时间有可能缩短。
