房室旁道导管消融术中零透视方法的有效性和安全性
Efficacy and Safety of Zero-Fluoroscopy Approach during Catheter Ablation of Accessory Pathway.
作者信息
Rodkiewicz Dariusz, Koźluk Edward, Piątkowska Agnieszka, Gąsecka Aleksandra, Krzemiński Krzysztof, Opolski Grzegorz
机构信息
Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland.
Chair of Emergency Medicine, Wroclaw Medical University, 02-091 Wrocław, Poland.
出版信息
J Clin Med. 2022 Mar 25;11(7):1814. doi: 10.3390/jcm11071814.
BACKGROUND
Catheter ablation (CA) is a safe and efficient treatment in patients with an atrioventricular accessory pathway (AP). Electroanatomical mapping (EAM) systems are useful during CA of AP, especially for reducing fluoroscopy. There are limited data about the feasibility of CA procedures performed with the use of the EAM system entirely without fluoroscopy in adults with AP. The aim of the study is to assess the feasibility, efficacy and safety of CA with the use of EAM without fluoroscopy, compared to CA with EAM and fluoroscopy in patients with AP.
METHODS
The study included 83 consecutive patients (age 38.25 ± 15.8 years), who were subjected to CA for AP. In 40 patients CA was performed with the use of EAM without fluoroscopy (EAM group), and in 43 patients CA was performed with EAM and fluoroscopy (control group). Baseline characteristics, procedure parameters and complications were obtained from the medical records. Data on permanent success rate was obtained after the mean follow-up time of 1 year. Primary outcomes were acute procedural success rate, long term success rate at 1-year follow-up and complications. Secondary outcomes were the procedure time and number of applications.
RESULTS
There were no statistically significant differences in baseline characteristics between the groups, except for the AP locations. Right-sided AP was more common in the EAM group, while left-sided AP was more common in the control group ( = 0.007 and = 0.004, respectively). Acute procedural success was achieved in 38 patients (95.0%) in the EAM group and in 39 patients (90.7%) in the control group ( = 0.449). Long term success rate was achieved in 36 patients (90.0%) in the EAM group and in 36 (83.7%) patients in the control group ( = 0.399). There was one minor complication in the form of RBBB in the EAM group ( = 0.138). The mean procedure time was shorter in the EAM group compared to the control group (93.0 ± 58.3 min vs. 127.6 ± 57.5 min; = 0.009).
CONCLUSIONS
CA of both right-sided and left-sided AP completely guided by EAM without the use of fluoroscopy is feasible, safe and effective.
背景
导管消融术（CA）是治疗房室旁道（AP）患者的一种安全有效的方法。电解剖标测（EAM）系统在AP的CA过程中很有用，特别是对于减少透视。关于在成年AP患者中完全不使用透视而使用EAM系统进行CA手术的可行性的数据有限。本研究的目的是评估与使用EAM和透视进行CA的患者相比，不使用透视而使用EAM进行CA的可行性、有效性和安全性。
方法
本研究纳入了83例连续接受AP的CA治疗的患者（年龄38.25±15.8岁）。40例患者在不使用透视的情况下使用EAM进行CA（EAM组），43例患者在使用EAM和透视的情况下进行CA（对照组）。从病历中获取基线特征、手术参数和并发症。在平均随访1年后获得永久成功率的数据。主要结局是急性手术成功率、1年随访时的长期成功率和并发症。次要结局是手术时间和应用次数。
结果
除AP位置外，两组间基线特征无统计学显著差异。右侧AP在EAM组中更常见，而左侧AP在对照组中更常见（分别为=0.007和=0.004）。EAM组38例患者（95.0%）和对照组39例患者（90.7%）实现了急性手术成功（=0.449）。EAM组36例患者（90.0%）和对照组36例患者（83.7%）实现了长期成功率（=0.399）。EAM组有1例以右束支传导阻滞形式出现的轻微并发症（=0.138）。与对照组相比，EAM组的平均手术时间更短（93.0±58.3分钟对127.6±57.5分钟；=0.009）。
结论
在不使用透视的情况下，完全由EAM引导的右侧和左侧AP的CA是可行、安全和有效的。
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