Subcarpathian Regional Hospital, Krosno, Poland.
Department of Cardiology, Regional Specialist Hospital, Stalowa Wola, Poland.
J Interv Card Electrophysiol. 2023 Aug;66(5):1231-1242. doi: 10.1007/s10840-022-01419-2. Epub 2022 Dec 10.
Radiofrequency catheter ablation (RFCA) of the slow pathway in atrioventricular nodal reentry tachycardia (AVNRT) is associated with high efficacy and low risk of total perioperative or late atrioventricular block. This study aimed to evaluate the efficacy, safety, and feasibility of slow-pathway RFCA for AVNRT using a zero-fluoroscopy approach.
Data were obtained from a prospective multicenter registry of catheter ablation from January 2012 to February 2018. Consecutive unselected patients with the final diagnosis of AVNRT were recruited. Electrophysiological and 3-dimensional (3D) electroanatomical mapping systems were used to create 3D maps and to navigate only 2 catheters from the femoral access. Acute procedural efficacy was evaluated using the isoproterenol and/or atropine test, with 15-min observation after ablation. Each case of recurrence or complication was consulted at an outpatient clinic during long-term follow-up.
Of the 1032 procedures, 1007 (97.5%) were completed without fluoroscopy. Conversion to fluoroscopy was required in 25 patients (2.5%), mainly due to an atypical location of the coronary sinus (n = 7) and catheter instability (n = 7). The mean radiation exposure time was 1.95 ± 1.3 min for these cases. The mean fluoroscopy time for the entire study cohort was 0.05 ± 0.4 min. The mean total procedure time was 44.8 ± 18.6 min. There were no significant in-hospital complications. The total success rate was 96.1% (n = 992), and the recurrence rate was 3.9% (n = 40).
Slow-pathway RFCA can be safely performed without fluoroscopy, with a minimal risk of complications and a high success rate.
房室结折返性心动过速（AVNRT）的慢径路射频导管消融（RFCA）具有高效和低总围手术期或晚期房室传导阻滞风险的特点。本研究旨在评估零透视技术用于 AVNRT 慢径路 RFCA 的疗效、安全性和可行性。
数据来自 2012 年 1 月至 2018 年 2 月的导管消融前瞻性多中心登记处。连续入选最终诊断为 AVNRT 的未经选择的患者。使用电生理和三维（3D）电解剖标测系统构建 3D 图谱，并仅从股动脉入路使用 2 根导管进行导航。在消融后观察 15 分钟，用异丙肾上腺素和/或阿托品试验评估急性程序疗效。在长期随访期间，在门诊咨询每次复发或并发症的病例。
1032 例手术中，有 1007 例（97.5%）在无透视下完成。25 例（2.5%）需要透视转换，主要原因是冠状窦位置异常（n=7）和导管不稳定（n=7）。这些病例的平均射线暴露时间为 1.95±1.3 分钟。整个研究队列的平均透视时间为 0.05±0.4 分钟。平均总手术时间为 44.8±18.6 分钟。无院内严重并发症。总成功率为 96.1%（n=992），复发率为 3.9%（n=40）。
在无透视的情况下，可以安全地进行慢径路 RFCA，并发症风险低，成功率高。
