三维引导和 ICE 引导下房间隔穿刺在心脏消融中的应用：倾向评分匹配研究。
Three-dimensional-guided and ICE-guided transseptal puncture for cardiac ablations: A propensity score match study.
机构信息
Cardiovascular Medicine Department, Center of Excellence in Arrhythmia Research, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, Michigan, USA.
出版信息
J Cardiovasc Electrophysiol. 2023 Feb;34(2):382-388. doi: 10.1111/jce.15756. Epub 2023 Jan 30.
INTRODUCTION
Transseptal puncture (TSP) is routinely performed for left atrial ablation procedures. The use of a three-dimensional (3D) mapping system or intracardiac echocardiography (ICE) is useful in localizing the fossa ovalis and reducing fluoroscopy use. We aimed to compare the safety and efficacy between 3D mapping system-guided TSP and ICE-guided TSP techniques.
METHODS
We conducted a prospective observational study of patients undergoing TSP for left atrial catheter ablation procedures (mostly atrial fibrillation ablation). Propensity scoring was used to match patients undergoing 3D-guided TSP with patients undergoing ICE-guided TSP. Logistic regression was used to compare the clinical data, procedural data, fluoroscopy time, success rate, and complications between the groups.
RESULTS
Sixty-five patients underwent 3D-guided TSP, and 151 propensity score-matched patients underwent ICE-guided TSP. The TSP success rate was 100% in both the 3D-guided and ICE-guided groups. Median needle time was 4.00 min (interquartile range [IQR]: 2.57-5.08) in patients with 3D-guided TSP compared to 4.02 min (IQR: 2.83-6.95) in those with ICE-guided TSP (p = .22). Mean fluoroscopy time was 0.2 min (IQR: 0.1-0.4) in patients with 3D-guided TSP compared to 1.2 min (IQR: 0.7-2.2) in those with ICE-guided TSP (p < .001). There were no complications related to TSP in both group.
CONCLUSIONS
Three-dimensional mapping-guided TSP is as safe and effective as ICE-guided TSP without additional cost.
简介
经房间隔穿刺（TSP）是左心房消融术的常规操作。使用三维（3D）映射系统或心内超声心动图（ICE）有助于定位卵圆窝并减少透视使用。我们旨在比较 3D 映射系统引导的 TSP 和 ICE 引导的 TSP 技术的安全性和有效性。
方法
我们进行了一项前瞻性观察研究，纳入接受 TSP 进行左心房导管消融术（主要为心房颤动消融）的患者。采用倾向评分匹配法将接受 3D 引导 TSP 的患者与接受 ICE 引导 TSP 的患者进行匹配。采用逻辑回归比较两组患者的临床资料、手术资料、透视时间、成功率和并发症。
结果
65 例患者接受了 3D 引导 TSP，151 例患者接受了 ICE 引导 TSP，3D 引导和 ICE 引导组的 TSP 成功率均为 100%。3D 引导 TSP 患者的穿刺针时间中位数为 4.00 分钟（四分位距 [IQR]：2.57-5.08），ICE 引导 TSP 患者为 4.02 分钟（IQR：2.83-6.95）（p=0.22）。3D 引导 TSP 患者的透视时间平均为 0.2 分钟（IQR：0.1-0.4），ICE 引导 TSP 患者为 1.2 分钟（IQR：0.7-2.2）（p<0.001）。两组均无与 TSP 相关的并发症。
结论
3D 映射引导的 TSP 与 ICE 引导的 TSP 一样安全有效，且没有额外费用。
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