Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 33100 Cleveland Clinic Blvd, Avon, OH, 44011, USA.
, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
J Interv Card Electrophysiol. 2021 Jun;61(1):165-170. doi: 10.1007/s10840-020-00798-8. Epub 2020 Jun 12.
To investigate the learning curve for atrial fibrillation (AF), supraventricular tachycardia (SVT), and premature ventricular contraction (PVC) radiofrequency ablation (RFA) using zero fluoroscopy.
This is a retrospective, single-center study of 167 patients undergoing ablation between 2016 and 2019. Minimal fluoroscopy approach was initiated after the first 20 cases of PVI and SVT RFA. Procedures were divided consecutively into increments of 10 cases to determine operator learning curve.
A total of 64 (38%) had SVT ablations, 26 (16%) had PVC ablations, and 77 (46%) had AF and underwent PVI. For SVT RFA, fluoroscopy time improved from 4.1 ± 3.5 min during the first 10 cases to 0.8 ± 1.2 min after 50 cases (p = 0.0001). Sixty-two out of 64 (97%) of cases were successful. In PVC RFA, fluoroscopy time was 7.7 ± 5.5 min for the first 5, 2.3 ± 3.4 min after 15, and 0 min after 20 cases (p = 0.0008). Twenty-four out of 26 (92%) of cases were acutely successful with recurrence in 2/26 (8%) of patients over 9 ± 9 months. In PVI, fluoroscopy time was 9.9 ± 3.3 min over the first 20 cases, 2.6 ± 2.3 min after 40 cases, and 0.1 min after 50 cases (p < 0.0001). PVI procedure time was 170 ± 34 min after 60 cases from 235 ± 41 min initially (p 0.001). Six out of 77 (8%) had AF recurrence at 12 months.
Zero fluoroscopy ablation for AF, SVT, and PVC can be safely achieved without increasing procedure time. The steepest learning curve occurs over the first 20, 15, and 40 cases for SVT, PVC, and PVI ablation respectively.
研究使用零透视技术行心房颤动（AF）、室上性心动过速（SVT）和室性早搏（PVC）射频消融术（RFA）的学习曲线。
这是一项回顾性、单中心研究，纳入了 2016 年至 2019 年间进行消融术的 167 名患者。在完成前 20 例 PVI 和 SVT RFA 后，采用最小透视方法。连续将手术分为 10 例一组，以确定操作者的学习曲线。
共 64 例（38%）行 SVT 消融术，26 例（16%）行 PVC 消融术，77 例（46%）行 AF 和 PVI。对于 SVT RFA，透视时间从第 10 例的 4.1±3.5 分钟改善至第 50 例的 0.8±1.2 分钟（p=0.0001）。62 例（97%）患者手术成功。在 PVC RFA 中，前 5 例透视时间为 7.7±5.5 分钟，第 15 例为 2.3±3.4 分钟，第 20 例为 0 分钟（p=0.0008）。26 例患者中，24 例（92%）即刻成功，26 例中有 2 例（8%）患者在 9±9 个月后复发。对于 PVI，透视时间在第 1 至 20 例为 9.9±3.3 分钟，第 40 例为 2.6±2.3 分钟，第 50 例为 0.1 分钟（p<0.0001）。第 20 例至 60 例 PVI 手术时间为 170±34 分钟，而初始手术时间为 235±41 分钟（p<0.001）。77 例患者中有 6 例（8%）在 12 个月时出现 AF 复发。
AF、SVT 和 PVC 的零透视消融术可以安全实施，且不会延长手术时间。对于 SVT、PVC 和 PVI 消融术，学习曲线最陡峭的分别是前 20、15 和 40 例。
