Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy.
JACC Clin Electrophysiol. 2021 Sep;7(9):1108-1117. doi: 10.1016/j.jacep.2021.02.017. Epub 2021 Apr 28.
This study aimed to assess the long-term outcomes of minimally fluoroscopic approach (MFA) compared with conventional fluoroscopic ablation (ConvA) in terms of recurrences of arrhythmia and long-term complications.
Catheter ablation (CA) of supraventricular tachycardia (SVT) with an MFA, under the guidance of electroanatomic mapping (EAM) systems, results in a significant reduction in exposure to ionizing radiations without impairing acute procedural success and complication rate. However, data regarding long-term outcomes of MFA compared with ConvA are lacking.
This is a retrospective observational study. All patients undergoing MFA CA of SVT (atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia) between 2010 and 2015 were enrolled and were compared with matched subjects (1 MFA: 2 ConvA) undergoing ConvA during the same period. The 2 co-primary outcomes were recurrence of arrhythmias and long-term complications.
A total of 618 patients (mean age 38 ± 15 years, 60% female) were enrolled. MFA included 206 patients, whereas 412 were treated with ConvA. Acute success (99% vs. 97%; p = 0.10) and acute complications (2.4% vs. 5.3%; p = 0.14) were similar in the 2 groups. During a median follow-up of 4.4 years, 5.9% of patients experienced recurrence of arrhythmias. At multivariate analysis, ConvA (hazard ratio [HR]: 3.03) and procedural success (HR: 0.10) were independently associated with recurrence of arrhythmias. Late complications (i.e., advance atrioventricular block and need for pacemaker implantation) occurred more frequently in ConvA (3.4% vs. 0.5%; p = 0.03) compared with MFA.
CA guided by EAM systems with MFA provided better long-term results and reduced risk of complications compared with ConvA.
本研究旨在评估微创入路（MFA）与传统透视消融（ConvA）在心律失常复发和长期并发症方面的长期结果。
在电解剖图（EAM）系统的指导下，对室上性心动过速（SVT）进行导管消融（CA），可显著减少电离辐射的暴露，而不影响急性手术成功率和并发症发生率。然而，关于 MFA 与 ConvA 相比的长期结果的数据尚缺乏。
这是一项回顾性观察性研究。所有在 2010 年至 2015 年间接受 MFA 治疗的 SVT（房室结折返性心动过速和房室折返性心动过速）CA 的患者都被纳入研究，并与同期接受 ConvA 治疗的匹配患者（1 MFA：2 ConvA）进行比较。两个主要终点是心律失常复发和长期并发症。
共纳入 618 例患者（平均年龄 38±15 岁，60%为女性）。MFA 组包括 206 例患者，ConvA 组 412 例。两组的急性成功率（99% vs. 97%；p=0.10）和急性并发症（2.4% vs. 5.3%；p=0.14）相似。在中位数为 4.4 年的随访期间，5.9%的患者出现心律失常复发。多变量分析显示，ConvA（风险比[HR]：3.03）和手术成功率（HR：0.10）与心律失常复发独立相关。晚期并发症（即，房室传导阻滞加重和需要植入起搏器）在 ConvA 组（3.4% vs. 0.5%；p=0.03）比 MFA 组更常见。
在 EAM 系统指导下进行的 CA 采用 MFA 可提供更好的长期结果，并降低与 ConvA 相关的并发症风险。
