Lin Changjian, Pehrson Steen, Jacobsen Peter Karl, Chen Xu
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Cardiovasc Electrophysiol. 2017 Dec;28(12):1387-1392. doi: 10.1111/jce.13332. Epub 2017 Sep 26.
There have been advancements of sophisticated mapping systems used for ablation procedures over the last decade. Utilization of these novel mapping systems in combination with remote magnetic navigation (RMN) needs to be established. We investigated the new EnSite Precision mapping system (St. Jude Medical, Inc., St. Paul, MN, USA), which collects magnetic data for checking navigation field stability and is built on an open platform, allowing physicians to choose diagnostic and ablation catheters. We address its compatibility with RMN.
To assess the clinical utility of a novel 3D mapping system (EnSite Precision mapping system) combined with RMN (Niobe ES, Stereotaxis, Inc., St. Louis, MO, USA) for atrial fibrillation (AF) ablation.
In this prospective nonrandomized study, two groups of patients were treated in our center for drug refractory AF. Patients were consecutively enrolled in each group. Group A (n = 35, 14 persistent AF [PsAF]) was treated using the novel 3D mapping system combined with RMN. Group B (n = 38, 16 PsAF) was treated using Carto 3 (Biosense Webster, Inc., Diamond Bar, CA, USA) combined with RMN. In Group A, the left atrium (LA) was mapped with a circular magnetic catheter manually and was then replaced by a RMN ablation catheter. At the end of the procedures in Group A, the circular catheter was used for confirming field stability. In Group B, an ablation catheter was controlled by RMN to perform both LA mapping and ablation. All patients underwent pulmonary vein antrum isolation. Additional complex fractionated atrial electrograms (CFAEs) ablation was performed for PsAF. Procedural, ablation, and fluoroscopy times were recorded and complications were assessed.
Electrophysiological end points were achieved in all patients. Using the novel mapping system, LA mapping time was fast (308 ± 60 seconds) with detailed anatomy points (178,831 ± 70,897) collected and magnetic points throughout LA. At the end of the procedures in Group A, the LA model was confirmed to be stable and its location was within the distance threshold (1 mm). Procedure time (117.9 ± 29.6 minutes vs. 119.2 ± 29.7 minutes, P = 0.89), fluoroscopy time (6.1 ± 2.4 minutes vs. 4.8 ± 2.2 minutes, P = 0.07), and ablation time (28.0 ± 12.9 minutes vs. 27.9 ± 15.8 minutes, P = 0.98) were similar in Group A versus Group B, respectively. No complications occurred in either group.
LA mapped by the novel system is stable and reliable. Combined with RMN, it could be effectively used for AF ablation without impacting overall procedural times.
在过去十年中，用于消融手术的精密标测系统取得了进展。需要确定这些新型标测系统与远程磁导航（RMN）结合使用的情况。我们研究了新的EnSite Precision标测系统（美国明尼苏达州圣保罗市圣犹达医疗公司），该系统收集磁数据以检查导航场稳定性，并且基于开放平台构建，允许医生选择诊断和消融导管。我们探讨了它与RMN的兼容性。
评估一种新型三维标测系统（EnSite Precision标测系统）与RMN（美国密苏里州圣路易斯市Stereotaxis公司的Niobe ES）相结合用于房颤（AF）消融的临床效用。
在这项前瞻性非随机研究中，我们中心对两组药物难治性AF患者进行了治疗。每组患者连续入组。A组（n = 35，14例持续性AF [PsAF]）使用新型三维标测系统结合RMN进行治疗。B组（n = 38，16例PsAF）使用Carto 3（美国加利福尼亚州钻石吧市Biosense Webster公司）结合RMN进行治疗。在A组中，使用环形磁导管手动对左心房（LA）进行标测，然后用RMN消融导管替换。在A组手术结束时，使用环形导管确认场稳定性。在B组中，通过RMN控制消融导管进行LA标测和消融。所有患者均接受肺静脉前庭隔离术。对PsAF患者进行了额外的复杂碎裂心房电图（CFAE）消融。记录手术、消融和透视时间，并评估并发症。
所有患者均达到电生理终点。使用新型标测系统，LA标测时间快（308±60秒），收集到详细的解剖学点（178,831±70,897）以及整个LA的磁点。在A组手术结束时，确认LA模型稳定，其位置在距离阈值（1毫米）内。A组与B组的手术时间（117.9±29.6分钟对119.2±29.7分钟，P = 0.89）、透视时间（6.1±2.4分钟对4.8±2.2分钟，P = 0.07）和消融时间（28.0±12.9分钟对27.9±15.8分钟，P = 0.98）分别相似。两组均未发生并发症。
新型系统标测的LA稳定可靠。与RMN相结合，它可有效用于AF消融，且不影响总体手术时间。
