Debreceni Dorottya, Janosi Kristof-Ferenc, Turcsan Marton, Toth Daniel, Bocz Botond, Simor Tamas, Kupo Peter
Heart Institute, Medical School, University of Pecs, Pecs, Hungary.
Front Cardiovasc Med. 2023 Oct 12;10:1244137. doi: 10.3389/fcvm.2023.1244137. eCollection 2023.
Catheter ablation is the preferred treatment for typical atrial flutter (AFl), but it can be challenging due to anatomical abnormalities. The use of 3D electroanatomical mapping systems (EAMS) has reduced fluoroscopy exposure during AFl ablation. Intracardiac echocardiography (ICE) has also shown benefits in reducing radiation exposure during AFl ablation. However, there is a lack of evidence on the feasibility of ICE-guided, zero-fluoroscopy AFl ablation without the use of EAMS.
In this prospective study, we enrolled 80 patients with CTI-dependent AFl. The first 40 patients underwent standard fluoroscopy + ICE-guided ablation (Standard ICE group), while the other 40 patients underwent zero-fluoroscopy ablation using only ICE (Zero ICE group). Procedure outcomes, including acute success, procedure time, fluoroscopy time, radiation dose, and complications, were compared between the groups.
The acute success rate was 100% in both groups. Out of the 40 cases, the zero-fluoroscopy strategy was successfully implemented in 39 cases (97.5%) in the Zero ICE group. There were no significant differences in procedure time [55.5 (46.5; 66.8) min vs. 51.5 (44.0; 65.5), = 0.50] and puncture to first ablation time [18 (13.5; 23) min vs. 19 (15; 23.5) min, = 0.50] between the groups. The Zero ICE group had significantly lower fluoroscopy time [57 (36.3; 90) sec vs. 0 (0; 0) sec, < 0.001] and dose [3.17 (2.27; 5.63) mGy vs. 0 (0; 0) mGy, < 0.001] compared to the Standard ICE group. Total ablation time was longer in the Standard ICE group [597 (447; 908) sec vs. 430 (260; 750), = 0.02], but total ablation energy [22,458 (14,836; 31,116) Ws vs. 17,043 (10,533; 29,302) Ws, = 0.10] did not differ significantly. First-pass bidirectional conduction block of the CTI and acute reconnection rates were similar between the groups. No complications or recurrences were observed during the follow-up period.
Our study suggests that zero-fluoroscopy CTI ablation guided solely by ICE for AFl is feasible and safe. Further investigation is warranted for broader validation.
导管消融是典型心房扑动（AFl）的首选治疗方法，但由于解剖结构异常，可能具有挑战性。三维电解剖标测系统（EAMS）的使用减少了AFl消融期间的透视暴露。心内超声心动图（ICE）在减少AFl消融期间的辐射暴露方面也显示出益处。然而，缺乏关于不使用EAMS的ICE引导下零透视AFl消融可行性的证据。
在这项前瞻性研究中，我们纳入了80例CTI依赖性AFl患者。前40例患者接受标准透视+ICE引导消融（标准ICE组），而其他40例患者仅使用ICE进行零透视消融（零ICE组）。比较两组的手术结果，包括急性成功率、手术时间、透视时间、辐射剂量和并发症。
两组的急性成功率均为100%。在40例病例中，零ICE组39例（97.5%）成功实施了零透视策略。两组之间的手术时间[55.5（46.5；66.8）分钟对51.5（44.0；65.5）分钟，P = 0.50]和穿刺至首次消融时间[18（13.5；23）分钟对19（15；23.5）分钟，P = 0.50]无显著差异。与标准ICE组相比，零ICE组的透视时间[57（36.3；90）秒对0（0；0）秒，P < 0.001]和剂量[3.17（2.27；5.63）毫戈瑞对0（0；0）毫戈瑞，P < 0.001]显著更低。标准ICE组的总消融时间更长[597（447；908）秒对430（260；750）秒，P = 0.02]，但总消融能量[22,458（14,836；31,116）瓦秒对17,043（10,533；29,302）瓦秒，P = 0.10]无显著差异。两组之间CTI的首次双向传导阻滞和急性再连接率相似。随访期间未观察到并发症或复发。
我们的研究表明，仅由ICE引导的零透视CTI消融治疗AFl是可行且安全的。需要进一步研究以进行更广泛的验证。
