Blockhaus Christian, Schmidt Jan, Kurt Muhammed, Clasen Lukas, Müller Patrick, Brinkmeyer Christoph, Kelm Malte, Shin Dong-In, Makimoto Hisaki
Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University, Medical Center Düsseldorf, Düsseldorf, Germany.
Arch Med Sci. 2018 Jun;14(4):794-800. doi: 10.5114/aoms.2016.61944. Epub 2016 Aug 23.
Ablation of the cavotricuspid isthmus (CTI) in patients with atrial flutter (AFL) and pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) are both common therapies. As the demand for ablative treatments rises, total radiation exposure times of staff increase concomitantly. Here, we report on our first experiences with a new fluoroscopy integrating system (FIS) integrated into a current 3D mapping system (3DMS).
The study population consisted of 59 consecutive patients who underwent PVI or CTI ablation (26 and 33 patients with and without FIS respectively). Total procedure time (PT), fluoroscopy exposure time (FT) and dose-area product (DAP) were monitored.
All procedures were successfully completed without major complications. Employing FIS in the PVI group, FT and DAP were both significantly reduced after completing a short learning curve of 6 cases (respectively 361.6 ±181 s vs. 530.3 ±156.7 s, = 0.039; 801.9 ±439.15 cGycm² vs. 1495 ±435.2 cGycm², = 0.002). Mean PT was not significantly affected (121 ±26.7 min vs. 135.6 ±23.2 min, = 0.21). The same holds true for CTI ablation: FT (99.29 ±51.4 s vs. 153.9 ±76.6 s, = 0.022) and DAP (269 ±128.7 cGycm² vs. 524.3 ±288.4 cGycm², = 0.002) were significantly reduced, leaving PT not significantly affected (29.5 ±10 min vs. 35.2 ±16.3 min, = 0.23).
The introduction of the new FIS with a current 3DMS results in a significant reduction of both the total FT and DAP without affecting PT. The initial learning curve for adopting this method is considerably short.
对心房扑动（AFL）患者进行三尖瓣峡部（CTI）消融以及对心房颤动（AF）患者进行肺静脉隔离（PVI）都是常见的治疗方法。随着消融治疗需求的增加，工作人员的总辐射暴露时间也随之增加。在此，我们报告了将一种新型透视集成系统（FIS）集成到当前三维标测系统（3DMS）中的首次经验。
研究人群包括59例连续接受PVI或CTI消融的患者（分别有26例和33例使用和未使用FIS）。监测了总手术时间（PT）、透视暴露时间（FT）和剂量面积乘积（DAP）。
所有手术均成功完成，无重大并发症。在PVI组中使用FIS，在完成6例的短学习曲线后，FT和DAP均显著降低（分别为361.6±181秒对530.3±156.7秒，P = 0.039；801.9±439.15 cGycm²对1495±435.2 cGycm²，P = 0.002）。平均PT未受到显著影响（121±26.7分钟对135.6±23.2分钟，P = 0.21）。CTI消融也是如此：FT（99.29±51.4秒对153.9±76.6秒，P = 0.022）和DAP（269±128.7 cGycm²对524.3±288.4 cGycm²，P = 0.002）显著降低，PT未受到显著影响（29.5±10分钟对35.2±16.3分钟，P = 0.23）。
将新型FIS与当前3DMS相结合可显著降低总FT和DAP，且不影响PT。采用这种方法的初始学习曲线相当短。
