Bocz Botond, Debreceni Dorottya, Janosi Kristof-Ferenc, Turcsan Marton, Simor Tamas, Kupo Peter
Heart Institute, Medical School, University of Pecs, Ifjusag Utja 13, H-7624 Pécs, Hungary.
J Clin Med. 2023 Aug 26;12(17):5577. doi: 10.3390/jcm12175577.
Radiofrequency (RF) catheter ablation is an effective treatment option for targeting the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT). Previous data suggested that using intracardiac echocardiography (ICE) guidance could improve procedural outcomes when compared to using fluoroscopy alone. In this prospective study, we aimed to compare the effectiveness of an electroanatomical mapping system (EAMS)-guided approach with an ICE-guided approach for SP ablation. Eighty patients undergoing SP ablation for AVNRT were randomly assigned to either the ICE-guided or EAMS-guided group. If the procedural endpoint was not achieved after 8 RF applications; patients were allowed to crossover to the ICE-guided group. The ICE-guided approach reduced the total procedure time (61.0 (56.0; 66.8) min vs. 71.5 (61.0; 80.8) min, < 0.01). However, the total fluoroscopy time was shorter (0 (0-0) s vs. 83.5 (58.5-133.25) s, < 0.001) and the radiation dose was lower (0 (0-0) mGy vs. 3.3 (2.0-4.7) mGy, < 0.001) with EAMS-guidance. The ICE-guided group had a lower number of RF applications (4 (3-5) vs. 5 (3.0-7.8), = 0.03) and total ablation time (98.5 (66.8-186) s vs. 136.5 (100.5-215.8) s, = 0.02). Nine out of 40 patients (22.5%) in the EAMS-guided group crossed over to the ICE-guided group, and they were successfully treated with similar RF applications in terms of number, time, and energy compared to the ICE-guided group. There were no recurrences during the follow-up period. In conclusion, the utilization of ICE guidance during SP ablation has demonstrated notable reductions in procedural time and RF delivery when compared to procedures guided by EAMS. In challenging cases, an early switch to ICE-guided ablation may be the optimal choice for achieving successful treatment.
射频（RF）导管消融是治疗房室结折返性心动过速（AVNRT）慢径（SP）的有效方法。既往数据表明，与单纯使用荧光透视相比，采用心腔内超声心动图（ICE）引导可改善手术效果。在这项前瞻性研究中，我们旨在比较心电解剖标测系统（EAMS）引导与ICE引导的SP消融方法的有效性。80例因AVNRT接受SP消融的患者被随机分为ICE引导组或EAMS引导组。如果在8次射频应用后未达到手术终点；允许患者交叉至ICE引导组。ICE引导方法缩短了总手术时间（61.0（56.0；66.8）分钟对71.5（61.0；80.8）分钟，<0.01）。然而，EAMS引导时总荧光透视时间更短（0（0 - 0）秒对83.5（58.5 - 133.25）秒，<0.001）且辐射剂量更低（0（0 - 0）毫戈瑞对3.3（2.0 - 4.7）毫戈瑞，<0.001）。ICE引导组的射频应用次数更少（4（3 - 5）对5（3.0 - 7.8），=0.03）且总消融时间更短（98.5（66.8 - 186）秒对136.5（100.5 - 215.8）秒，=0.02）。EAMS引导组的40例患者中有9例（22.5%）交叉至ICE引导组，与ICE引导组相比，他们在射频应用的次数、时间和能量方面得到了类似的成功治疗。随访期间无复发。总之，与EAMS引导的手术相比，SP消融期间使用ICE引导已显示出手术时间和射频释放的显著减少。在具有挑战性的病例中，早期切换至ICE引导的消融可能是实现成功治疗的最佳选择。
