From the Cardiology Department, Ospedale Alessandro Manzoni, Lecco, Italy (A.P., R.B., G.d.V.); Cardiology Department, Ospedale Treviglio e Caravaggio, Italy (G.B.); Cardiology Department, Ospedale San Bortolo, Vicenza, Italy (C.B.); Cardiology Department, Ospedale Cisanello, Azienda Ospedalieria Universitaria, Pisa, Italy (M.G.B.); Cardiology Department, Ospedale Santa Maria Nuova, Reggio Emilia, Italy (N.B.); Cardiology Department, Ospedale San Gerardo, Monza, Italy (S.d.C., G.R.); Arrhythmology Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milano, Italy (P.D.B., P.V.); Cardiology Department, Ospedale San Carlo Borromeo, Milano, Italy (D.M.); Cardiology Department, Ospedale ASO S. Croce e Carle, Cuneo, Italy (E.M.); Johnson & Johnson Med, Biosense Webster Italy, Milano (V.N.); Cardiology Department, Ospedale San Paolo, Milano, Italy (M.S.N.); Cardiology Department, Ospedale Santissima Trinità, Cagliari, Italy (S.O.); Cardiology Department, Ospedale S. Antonio Abate, Gallarate, Italy (D.O.); Cardiology Department, Ospedale San Filippo Neri, Roma, Italy (C.P.); Cardiology Department, A.S.S.T Grande Ospedale Metropolitano Niguarda, Milano, Italy (S.P.); Cardiology Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy (D.P., L.R.); Cardiology Department, Ospedale San Carlo Poma, Mantova, Italy (P.P.); Cardiology Department, Azienda Ospedaliera SS. Antonio e Biagio, Alessandria, Italy (A.S.); Cardiology Department, Ospedale Multimedica, Sesto San Giovanni, Italy (A.V.); Cardiology Department, Ospedale San Francesco, Nuoro, Italy (G.V.); Cardiology Department, Ospedale Santa Maria alle Scotte, Siena, Italy (V.Z.); and Cardiology Department, Ospedale Civile, Mirano, Italy (F.Z.).
Circ Arrhythm Electrophysiol. 2018 Mar;11(3):e005592. doi: 10.1161/CIRCEP.117.005592.
This multicenter, prospective study evaluated the determinants of zero-fluoroscopy (ZFL) ablation of supraventricular tachycardias.
Four hundred thirty patients (215 male, 55.4±22.1 years) with indication to electrophysiological study or ablation of supraventricular tachycardias were enrolled. All participating physicians agreed to follow the as low as reasonably achievable policy. A procedure was defined as ZFL when no fluoroscopy was used. The total fluoroscopy time inversely correlated to the number of procedures previously performed by each operator since study start (=-0.112; =0.02). Two hundred eighty-nine procedures (67.2%) were ZFL; multivariable analysis identified as predictors of ZFL: procedure after the 30th for each operator, compared with procedures up to the ninth (=0.011; hazard ratio, 3.49; 95% confidence interval [CI], 1.79-6.80); the type of arrhythmia (=0.031; electrophysiological study and atrioventricular nodal reentry tachycardia ablation having the highest probability of ZFL; hazard ratio, 6.87; 95% CI, 2.08-22.7 and hazard ratio, 2.02; 95% CI, 1.04-3.91, respectively); the operator's (=0.002) and patient's age (=0.009). Among operators, achievement of ZFL varied from 0% to 100%; 8 (22.8%) operators achieved ZFL in <25% of their procedures; 17 (48.6%) operators achieved ZFL in >75% of their procedures. The probability of ZFL increased by 2.8% (hazard ratio, 0.98; 95% CI, 0.97-0.99) as patient's age decreased by 1 year. Acute procedural success was obtained in all cases.
The use of 3-dimensional mapping system completely avoided the use of fluoroscopy in most cases, with very low fluoroscopy time in the remaining and high safety and effectiveness profiles. Achievement of ZFL was predicted by the type of arrhythmia, operator's experience, and patient's age.
这项多中心前瞻性研究评估了无透视（ZFL）消融治疗室上性心动过速的决定因素。
共有 430 名（男 215 名，55.4±22.1 岁）有行电生理检查或消融治疗室上性心动过速适应证的患者入组。所有参与的医生都同意遵循尽可能低的透视原则。如果未使用透视，则将手术定义为 ZFL。透视总时间与每位医生自研究开始以来进行的操作次数呈负相关（=-0.112；=0.02）。289 例（67.2%）为 ZFL；多变量分析确定 ZFL 的预测因素为：与前 9 次操作相比，第 30 次及以后的操作（=0.011；危险比，3.49；95%置信区间[CI]，1.79-6.80）；心律失常类型（=0.031；电生理检查和房室结折返性心动过速消融术具有最高的 ZFL 概率；危险比，6.87；95%CI，2.08-22.7 和危险比，2.02；95%CI，1.04-3.91，分别）；术者（=0.002）和患者年龄（=0.009）。在术者中，ZFL 的实现率从 0%到 100%不等；8 名（22.8%）术者的操作中<25%实现 ZFL；17 名（48.6%）术者的操作中>75%实现 ZFL。患者年龄每降低 1 岁，ZFL 的概率增加 2.8%（危险比，0.98；95%CI，0.97-0.99）。所有病例均获得急性手术成功。
使用 3 维标测系统完全避免了透视的使用，大多数病例透视时间非常低，安全性和有效性很高。ZFL 的实现预测因素为心律失常类型、术者经验和患者年龄。
