McCauley Mark D, Patel Nisarg, Greenberg Scott J, Molina-Razavi Joanna E, Safavi-Naeini Payam, Razavi Mehdi
Department of Medicine, Section of Cardiology, The University of Illinois at Chicago and the Jesse Brown VA Medical Center, Chicago, Illinois, US.
The Wright Center, Wilkes-Barre, Pennsylvania, US.
Eur J Arrhythm Electrophysiol. 2016 Winter;2(2):57-61. doi: 10.17925/EJAE.2016.02.02.57.
Fluoroscopy is traditionally used in atrial transseptal puncture (TSP); however fluoroscopy exposes patient and physician to excess radiation. Here, we describe a feasibility study of a zero-fluoroscopy transseptal puncture (ZFTSP) technique utilising electroanatomical mapping (EAM) and intracardiac echo (ICE) in a small case series of patients undergoing ablation for atrial fibrillation (AF). We then compare this technique to other established ZFTSP techniques for paroxysmal AF ablation.
Seven patients received ZFTSP. An Acunav™ ICE catheter (Biosense Webster Inc., California, US) was placed in the right atrium, then an Agilis™ sheath (St. Jude Medical, Saint Paul, Minnesota, US) was established into the inferior vena cava. A ThermoCool SmartTouch™ catheter (Biosense Webster Inc., California, US) was inserted through the Agilis to map the fossa ovalis. Mapping catheter exchange for dilator and needle allowed for facile ZFTSP. AF outcome, fluoroscopy times, and procedure times were compared with eight age-matched control patients.
There were no significant differences in age, body mass index (BMI) or AF duration between the two groups and no immediate complications. ZFTSP procedure time was 183.9±33.7 minutes versus 293.13±129.9 minutes for TSP-only controls (p=0.05). Fluoroscopy time was 17.5±14.1 minutes in ZFTSP patients versus 73.4±50.3 minutes in controls (p=0.01). AF recurrence in ZFTSP patients was 14% versus 25% in controls.
ZFTSP utilising ICE and EAM is safe, effective, and time-efficient. There is a small but significant reduction in radiation exposure to patient and physician by the use of this technique.
传统上，荧光透视用于房间隔穿刺（TSP）；然而，荧光透视会使患者和医生暴露于过量辐射中。在此，我们描述了一项在一小系列接受房颤（AF）消融治疗的患者中使用电解剖标测（EAM）和心内超声（ICE）的零荧光透视房间隔穿刺（ZFTSP）技术的可行性研究。然后，我们将该技术与其他已确立的用于阵发性房颤消融的ZFTSP技术进行比较。
7例患者接受了ZFTSP。将一根Acunav™ ICE导管（美国加利福尼亚州Biosense Webster公司）置于右心房，然后将一根Agilis™鞘管（美国明尼苏达州圣保罗市圣犹达医疗公司）置入下腔静脉。通过Agilis插入一根ThermoCool SmartTouch™导管（美国加利福尼亚州Biosense Webster公司）以标测卵圆窝。将标测导管换成扩张器和穿刺针以顺利进行ZFTSP。将房颤治疗结果、荧光透视时间和手术时间与8例年龄匹配的对照患者进行比较。
两组患者在年龄､体重指数（BMI）或房颤持续时间方面无显著差异，且无即刻并发症。ZFTSP手术时间为183.9±33.7分钟，而仅行TSP的对照组为293.13±129.9分钟（p = 0.05）。ZFTSP患者的荧光透视时间为17.5±14.1分钟，而对照组为73.4±50.3分钟（p = 0.01）。ZFTSP患者的房颤复发率为14%，而对照组为25%。
利用ICE和EAM的ZFTSP安全､有效且省时。使用该技术可使患者和医生所受辐射暴露有小幅但显著的减少。
