Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy.
Int J Cardiovasc Imaging. 2020 Sep;36(9):1599-1607. doi: 10.1007/s10554-020-01884-8. Epub 2020 May 23.
To evaluate predictors of zero-X ray procedures for supraventricular arrhythmias (SVT) using minimally fluoroscopic approach (MFA). Patients referred for RF catheter ablation of SVT were admitted for a MFA with an electro-anatomical navigation system or a conventional fluoroscopic approach (ConvA). Exclusion criterion was the need to perform a transseptal puncture. 206 patients (98 men, age 53 ± 19 years) underwent an EP study, 93 (45%) with an MFA and 113 (55%) with a ConvA. Fifty-five had no inducible arrhythmias (EPS). Fifty-four had AV nodal reentrant tachycardia (AVNRT), 49 patients had typical atrial flutter (AFL), 37 had AV reciprocating tachycardia (AVRT/WPW), 11 had focal atrial tachycardia (AT), and underwent a RF ablation. X-ray was not used at all in 51/93 (58%) procedures (zero X ray). MFA was associated with a significant reduction in total fluoroscopy time (5.5 ± 10 vs 13 ± 18 min, P = 0.01) and operator radiation dose (0.8 ± 2.5 vs 3 ± 8.2 mSV, P < 0.05). The greatest absolute dose reduction was observed in AVNRT (0.1 ± 0.3 vs 5.1 ± 10 mSV, P = 0.01, 98% relative dose reduction) and in AFL (1.3 ± 3.6 vs 11 ± 16 mSV, P = 0.003, 88% relative dose reduction) groups. Both AVNRT or AFL resulted the only statistically significant predictors of zero x ray at multivariate analysis (OR 4.5, 95% CI 1.5-13 and OR 5, 95% CI 1.7-15, P < 0.001, respectively). Success and complication rate was comparable between groups (P = NS). Using MFA for SVT ablation, radiological exposure is significantly reduced. Type of arrhythmia is the strongest predictor of zero X ray procedure.
评估经最小透视（MFA）方法治疗室上性心律失常（SVT）的零射线手术的预测因子。因 SVT 行射频导管消融术的患者接受了电生理检查，包括使用电解剖导航系统或传统透视方法（ConvA）进行 MFA。排除标准是需要进行经房间隔穿刺。206 例患者（98 例男性，年龄 53±19 岁）进行了电生理研究，其中 93 例（45%）接受了 MFA，113 例（55%）接受了 ConvA。55 例无诱发性心律失常（EPS）。54 例为房室结折返性心动过速（AVNRT），49 例为典型房扑（AFL），37 例为房室折返性心动过速（AVRT/WPW），11 例为局灶性房性心动过速（AT），并进行了射频消融术。在 93 例（58%）无射线的手术中，完全不使用 X 射线（零射线）。与 ConvA 相比，MFA 显著减少透视总时间（5.5±10 分钟比 13±18 分钟，P=0.01）和术者辐射剂量（0.8±2.5 毫西弗比 3±8.2 毫西弗，P<0.05）。在 AVNRT（0.1±0.3 毫西弗比 5.1±10 毫西弗，P=0.01，98%相对剂量减少）和 AFL（1.3±3.6 毫西弗比 11±16 毫西弗，P=0.003，88%相对剂量减少）组中，观察到绝对剂量的最大减少。在多变量分析中，仅 AVNRT 或 AFL 是零射线的统计学显著预测因子（OR 4.5，95%CI 1.5-13 和 OR 5，95%CI 1.7-15，P<0.001）。两组的成功率和并发症发生率无差异（P=NS）。在 SVT 消融中使用 MFA 可显著降低放射学暴露。心律失常类型是零射线手术的最强预测因子。
