Section of Pacing and Electrophysiology, Division of Cardiology, Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Heart Centre, National University Hospital, Singapore.
Pacing Clin Electrophysiol. 2020 Aug;43(8):822-827. doi: 10.1111/pace.13935. Epub 2020 Jul 11.
There are unique advantages and disadvantages in the choice of contact mapping (CM) versus noncontact mapping (NCM) systems during ablation of right ventricular outflow tract (RVOT) arrhythmias. This study compared acute procedural success and clinical outcomes in matched patients undergoing CM- versus NCM-guided RVOT ablation.
A total of 167 consecutive patients with idiopathic RVOT ventricular arrhythmias underwent NCM- or CM-guided ablation. Propensity scoring was used to match each patient undergoing NCM-guided ablation to one control patient undergoing CM-guided ablation.
A total of 120 patients were included in this final analysis. If initial ablation was acutely unsuccessful in either group, patients crossed over to the other group. Ablation was acutely successful in 47 of 60 (78.3 %) patients in the NCM group and 55 of 60 (91.7%) in the CM group (P = .002). Thirteen NCM patients required CM and two CM patients crossed over to utilize NCM (P = .002). Procedural duration, fluoroscopy time, and dose in NCM were greater than that in CM (P < .05, respectively). However, procedural complications were not different between two groups. During a mean follow-up of 51 ± 20.6 months, 51 of the 60 NCM patients remained free of arrhythmia, while 48 of the 60 CM patients had no recurrent arrhythmias (P = .47).
Contact mapping, compared to NCM, is the superior initial technique to guide RVOT arrhythmia ablation due to a higher procedural success without the need to switch to alternative mapping techniques and shorter procedural and fluoroscopic times.
在右心室流出道（RVOT）心律失常消融过程中，选择接触式标测（CM）与非接触式标测（NCM）系统各有独特的优势和劣势。本研究比较了在接受 CM-与 NCM 指导的 RVOT 消融的匹配患者中，即刻程序成功率和临床结局。
共 167 例特发性 RVOT 室性心律失常患者接受了 NCM-或 CM 指导的消融。采用倾向评分将每例接受 NCM 指导消融的患者与 1 例接受 CM 指导消融的对照患者进行匹配。
最终分析共纳入 120 例患者。如果两组中初始消融均不成功，患者交叉至另一组。NCM 组 60 例患者中有 47 例（78.3%）即刻消融成功，CM 组中有 55 例（91.7%）即刻消融成功（P=0.002）。13 例 NCM 患者需要 CM，2 例 CM 患者交叉使用 NCM（P=0.002）。NCM 的手术时间、透视时间和剂量均大于 CM（分别为 P<0.05）。然而，两组之间的手术并发症无差异。在平均 51±20.6 个月的随访中，60 例 NCM 患者中有 51 例无心律失常，60 例 CM 患者中有 48 例无心律失常复发（P=0.47）。
与 NCM 相比，CM 是指导 RVOT 心律失常消融的首选初始技术，因其具有更高的程序成功率，而无需切换至替代标测技术，且手术时间和透视时间更短。
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