Department of Cardiology, University of Missouri School of Medicine, One Hospital Drive, Columbia, MO, USA.
University of Missouri School of Medicine, Columbia, MO, USA.
J Interv Card Electrophysiol. 2022 Sep;64(3):743-749. doi: 10.1007/s10840-022-01151-x. Epub 2022 Feb 19.
Arterial invasive monitoring is the most common method in the USA for hemodynamic monitoring during atrial fibrillation (AF) ablation. Although studies have shown favorable comparison between non-invasive and invasive hemodynamic monitoring (IHM) in non-cardiac procedures under general anesthesia, limited data is available for complex cardiac procedures such as AF ablation in the USA. With progressive improvement in AF ablation procedural safety, particularly with routine use of intracardiac echocardiography (ICE) to monitor for pericardial effusion, it is unclear if invasive hemodynamic monitoring provides any advantage over non-invasive methods. Therefore, the purpose of this study is to determine whether noninvasive hemodynamic monitoring is non-inferior to invasive hemodynamic monitoring during AF ablation under general anesthesia in patients without major cardiac structural abnormality.
A multi-center retrospective data of AF ablation from July 2019 to December 2020 was extracted. A total of three hundred and sixty-two patients (362) were included, which were divided into group A (non-invasive hemodynamic monitoring) and group B (invasive hemodynamic monitoring). The primary outcome was to compare procedural safety between the two groups.
Out of 362 patients, 184 (51%) received non-invasive and 178 (49%) received invasive hemodynamic monitoring with similar baseline characteristics. There was no significant difference between the two groups in complication rates (groin hematoma, pericardial effusion, cardiac tamponade). Mean procedure time was longer in group B with 3.35% arterial site discomfort. Urgent arterial access was required in only 1 patient in group A.
This retrospective multicenter study strongly suggests that catheter ablation for atrial fibrillation under general anesthesia can be safely performed with noninvasive hemodynamic monitoring without requiring arterial access, with potential benefit in procedural duration and cost.
在美国，动脉有创监测是心房颤动（AF）消融过程中血流动力学监测最常用的方法。尽管研究表明，在全身麻醉下进行非心脏手术时，非侵入性和侵入性血流动力学监测（IHM）之间存在有利的比较，但在美国，关于 AF 消融等复杂心脏手术的资料有限。随着 AF 消融程序安全性的逐步提高，特别是常规使用心内超声（ICE）监测心包积液，侵入性血流动力学监测是否优于非侵入性方法尚不清楚。因此，本研究的目的是确定在无重大心脏结构异常的患者中，全身麻醉下 AF 消融时，非侵入性血流动力学监测是否不劣于侵入性血流动力学监测。
从 2019 年 7 月至 2020 年 12 月，提取了 AF 消融的多中心回顾性数据。共纳入 362 例患者（362 例），分为 A 组（非侵入性血流动力学监测）和 B 组（侵入性血流动力学监测）。主要结局是比较两组的程序安全性。
在 362 例患者中，184 例（51%）接受非侵入性和 178 例（49%）接受侵入性血流动力学监测，两组基线特征相似。两组并发症发生率（腹股沟血肿、心包积液、心脏压塞）无显著差异。B 组的平均手术时间较长，动脉部位不适发生率为 3.35%。仅 A 组有 1 例患者需要紧急动脉入路。
这项回顾性多中心研究强烈表明，全身麻醉下导管消融治疗心房颤动可以安全进行，无需动脉入路，在手术时间和成本方面具有潜在优势。
