Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany.
Department of Cardiology, Pulmology and Angiology, Landshut-Achdorf Hospital, Landshut, Germany.
J Cardiovasc Electrophysiol. 2018 Jan;29(1):160-166. doi: 10.1111/jce.13354. Epub 2017 Oct 26.
Stochastic damage of the ionizing radiation to both patients and medical staff is a drawback of fluoroscopic guidance during catheter ablation of cardiac arrhythmias. Therefore, emerging zero-fluoroscopy catheter-guidance techniques are of great interest.
We investigated, in a prospective pilot study, the feasibility and safety of the cryothermal (CA) slow-pathway ablation in patients with symptomatic atrioventricular-nodal-re-entry-tachycardia (AVNRT) using solely intracardiac echocardiography (ICE) for endovascular and endocardial catheter visualization. Twenty-five consecutive patients (mean age 55.6 ± 12.0 years, 17 female) with ECG-documentation or symptoms suggesting AVNRT underwent an electrophysiology study (EPS) in our laboratory utilizing ICE for catheter navigation. Supraventricular tachycardia was inducible in 23 (92%) patients; AVNRT was confirmed by appropriate stimulation maneuvers in 20 (80%) patients. All EPS in the AVNRT subgroup could be accomplished without need for fluoroscopy, relying solely on ICE-guidance. CA guided by anatomical location and slow-pathway potentials was successful in all patients, median cryo-mappings = 6 (IQR:3-10), median cryo-ablations = 2 (IQR:1-3). Fluoroscopy was used to facilitate the trans-septal puncture and localization of the ablation substrate in the remaining 3 patients (one focal atrial tachycardia and two atrioventricular-re-entry-tachycardias). Mean EPS duration in the AVNRT subgroup was 99.8 ± 39.6 minutes, ICE guided catheter placement 11.9 ± 5.8 minutes, time needed for diagnostic evaluation 27.1 ± 10.8 minutes, and cryo-application duration 26.3 ± 30.8 minutes.
ICE-guided zero-fluoroscopy CA in AVNRT patients is feasible and safe. Real-time visualization of the true endovascular borders and cardiac structures allow for safe catheter navigation during the ICE-guided EPS and might be an alternative to visualization technologies using geometry reconstructions.
在心脏心律失常的导管消融过程中，电离辐射对患者和医务人员的随机损伤是透视引导的一个缺点。因此，新兴的无透视导管引导技术具有很大的吸引力。
我们在一项前瞻性的试点研究中，调查了仅使用心腔内超声（ICE）进行血管内和心内膜导管可视化，对有症状的房室结折返性心动过速（AVNRT）患者进行冷冻（CA）慢径消融的可行性和安全性。25 名连续的患者（平均年龄 55.6 ± 12.0 岁，17 名女性），心电图记录或提示 AVNRT 的症状，在我们的实验室中接受了电生理研究（EPS），该研究使用 ICE 进行导管导航。23 名（92%）患者可诱发出室上性心动过速；20 名（80%）患者通过适当的刺激操作证实了 AVNRT。所有 AVNRT 亚组的 EPS 都可以在无需透视的情况下完成，仅依靠 ICE 引导。根据解剖位置和慢径电位进行 CA 引导，在所有患者中均获得成功，冷冻映射中位数=6（IQR：3-10），冷冻消融中位数=2（IQR：1-3）。在另外 3 名患者（1 例局灶性房性心动过速和 2 例房室折返性心动过速）中，透视用于辅助经房间隔穿刺和消融基质的定位。AVNRT 亚组的平均 EPS 持续时间为 99.8 ± 39.6 分钟，ICE 引导的导管放置时间为 11.9 ± 5.8 分钟，诊断评估所需时间为 27.1 ± 10.8 分钟，冷冻应用时间为 26.3 ± 30.8 分钟。
在 AVNRT 患者中，ICE 引导的无透视 CA 是可行和安全的。实时显示真实的血管内边界和心脏结构，允许在 ICE 引导的 EPS 期间进行安全的导管导航，并且可能替代使用几何重建的可视化技术。
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