Department of Cardiology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Cardiology, Shanghai Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Cardiology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Int J Cardiol. 2018 Sep 15;267:94-99. doi: 10.1016/j.ijcard.2018.03.105.
The purpose of this study was to assess the role of remote magnetic navigation (RMN) in the ablation of ventricular premature complexes (VPCs) arising from outflow tracts (OT) and valve annuli by comparing to manual control navigation (MCN).
A total of 152 patients with frequent VPCs were prospectively enrolled. 64 (42%) patients underwent ablation guided by RMN. Acute success rate was defined as the complete elimination and non-inducibility of clinical VPCs during the procedure.
Overall, acute success rate of RMN group was not different from MCN group (87.5% vs 84.1%, p = 0.56). Compared to MCN group, the fluoroscopic time of OT-VPCs ablation in the RMN group was significantly reduced by 67% (2.9 ± 2.3 min vs 8.9 ± 9.7 min, p = 0.006), and the ablation applications in successful cases were significantly reduced (11 ± 7 vs 15 ± 11, p = 0.018). Compared to MCN, RMN significantly decreased ablation applications (15 ± 9 vs 23 ± 9, p = 0.013) in the acute success rates of ablating VPCs of valve annulus, and has a trend of a higher success rate for VPCs arising from tricuspid annulus (10/11 vs 7/12, p = 0.193). No complications occurred in the RMN group. Three cases of cardiac tamponade and one case of transient atrioventricular block occurred in the MCN group (p = 0.22). After a mean follow up of 16.2 months, 2/56 and 3/74 patients had a recurrence of VPCs in the RMN group and MCN group respectively (p = 0.75).
When compared to MCN, RMN-guided ablation for VPCs was just as effective and safe, with the added benefit of reduced fluoroscopic time and fewer ablation applications.
本研究旨在通过比较远程磁导航（RMN）与手动控制导航（MCN），评估 RMN 在治疗流出道（OT）和瓣环起源室性早搏（VPCs）中的作用。
前瞻性纳入 152 例频发 VPCs 患者。64 例（42%）患者接受 RMN 指导下消融。即刻成功率定义为术中完全消除和诱发性临床 VPCs。
总体而言，RMN 组与 MCN 组即刻成功率无差异（87.5%比 84.1%，p=0.56）。与 MCN 组相比，RMN 组 OT-VPCs 消融的透视时间明显减少 67%（2.9±2.3min 比 8.9±9.7min，p=0.006），且成功病例中的消融应用明显减少（11±7 比 15±11，p=0.018）。与 MCN 相比，RMN 显著减少了瓣环起源 VPCs 即刻成功率的消融应用（15±9 比 23±9，p=0.013），且三尖瓣环起源 VPCs 的成功率有增高趋势（10/11 比 7/12，p=0.193）。RMN 组无并发症发生。MCN 组发生 3 例心脏压塞和 1 例一过性房室传导阻滞（p=0.22）。RMN 组和 MCN 组分别有 2/56 和 3/74 例患者在平均随访 16.2 个月后出现 VPCs 复发（p=0.75）。
与 MCN 相比，RMN 指导消融治疗 VPCs 同样有效且安全，还具有透视时间缩短和消融应用减少的额外益处。
