Department of Cardiology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany.
Europace. 2023 Apr 15;25(4):1339-1344. doi: 10.1093/europace/euac258.
The goal of this case series was to evaluate the feasibility, safety, and advantages of a wire-based approach for the live visualization of coronary arteries (CAs) in an electroanatomic mapping (EAM) system and to assess its diagnostic information.
For this single-centre case series, we included procedures in which close proximity of a possible ablation site to any epicardial vessel was suspected. An uncoated-tip guidewire was introduced into the relevant CAs after exclusion of critical CA stenosis by coronary angiography. By connecting this wire to the EAM system using a clip and pin connection, mapping and live visualization of the wire tip is possible, as well as the assessment of the local electrograms within the respective CAs. Procedural wire insertion and intracoronary mapping was performed by EP specialists and was assisted to judge the relevance of CA disease by an interventional cardiologist. A total of nine procedures in nine patients were included in this case series, four ventricular tachycardia ablation procedures and five procedures for the ablation of premature ventricular contractions. The left CAs were mapped in eight cases and the right CA was mapped in one case. In two cases, epicardial mapping was combined with visualization of the right or left CAs. There were no complications attributed to coronary wiring and mapping in this case.
We demonstrated the feasibility and safety of CA visualization and integration in an EAM. The live visualization of the CAs added valuable information without the need for preprocedural planning or the purchase of separate software. Electroanatomic visualization was achieved intraprocedurally in a safe and straightforward manner, adding critical diagnostic information without excessive costs or risks.
本病例系列旨在评估一种基于导丝的方法在电解剖标测（EAM）系统中实时可视化冠状动脉（CA）的可行性、安全性和优势，并评估其诊断信息。
在这项单中心病例系列研究中，我们纳入了怀疑可能消融部位与任何心外膜血管接近的病例。在排除冠状动脉造影显示的关键 CA 狭窄后，将未涂层尖端导丝引入相关 CA。通过使用夹子和销钉将该导丝连接到 EAM 系统，可以对导丝尖端进行标测和实时可视化，并评估相应 CA 内的局部电图。EP 专家进行了程序导丝插入和冠状动脉内标测，介入心脏病专家协助判断 CA 疾病的相关性。本病例系列共纳入 9 例 9 例患者的 9 例手术，其中 4 例室性心动过速消融术，5 例室性早搏消融术。在 8 例病例中对左 CA 进行了标测，在 1 例病例中对右 CA 进行了标测。在 2 例病例中，结合心外膜标测对右或左 CA 进行了可视化。在本病例中，没有归因于冠状动脉布线和标测的并发症。
我们证明了 CA 可视化和在 EAM 中整合的可行性和安全性。CA 的实时可视化无需术前规划或购买单独的软件即可提供有价值的信息。电解剖可视化在安全、直接的方式下在手术过程中实现，提供了关键的诊断信息，而不会增加过多的成本或风险。
