Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany.
Herzschrittmacherther Elektrophysiol. 2023 Dec;34(4):305-310. doi: 10.1007/s00399-023-00977-w. Epub 2023 Nov 10.
Atrioventricular-nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia, particularly in younger patients. The treatment of choice is radiofrequency catheter ablation (RFCA), traditionally necessitating ionizing radiation for catheter guidance.
The authors aimed to demonstrate the feasibility and safety of zero-fluoroscopy RFCA of AVNRT using EnSite™ NavX™ as a three-dimensional (3D) electroanatomical mapping system (EAM).
The authors retrospectively analyzed 68 patients that underwent AVNRT-RFCA. One group was a priori allocated to conventional fluoroscopy mapping (convFluoro, n = 30). In 38 cases, the electrophysiologist chose to use 3D-EAM for ablation. Of these patients, 20 could be ablated without fluoroscopy use (zeroFluoro). In 18 cases that were initially intended as 3D-EAM, additional fluoroscopy use was necessary due to difficult anatomic conditions (convertedFluoro). Procedure duration, fluoroscopy duration and dose, as well as complications were analyzed.
Procedure duration was similar for the convFluoro and zeroFluoro groups (74 ± 24 min vs. 80 ± 26 min, p = ns). The convertedFluoro group showed longer procedure duration compared to the convFluoro group (94 ± 30 min vs. 74 ± 24 min, p < 0.05). The use of 3D-EAM significantly reduced fluoroscopy duration comparing the convFluoro with the convertedFluoro group (12 ± 9 min vs. 7 ± 6 min, p < 0.05). The difference in fluoroscopy dose between convFluoro and convertedFluoro did not reach significance (169 ± 166 cGycm vs. 134 ± 137 cGycm, p = ns). In zeroFluoro cases, no radiation was used at all. 3D-EAM-guided RFCA was primarily successful in all patients. Overall, there were only few minor complications in the different groups. No major complications occurred.
Zero-fluoro RFCA in patients with AVNRT is feasible and safe. 3D-EAM can reduce radiation exposure in the majority of patients without prolonging procedure duration or increasing complications.
房室结折返性心动过速（AVNRT）是一种常见的室上性心动过速，尤其在年轻患者中更为常见。治疗的首选方法是射频导管消融（RFCA），传统上需要电离辐射来引导导管。
作者旨在证明使用 EnSite™ NavX™ 作为三维（3D）电解剖标测系统（EAM）进行零透视 RFCA 治疗 AVNRT 的可行性和安全性。
作者回顾性分析了 68 例接受 AVNRT-RFCA 的患者。一组患者预先分配至常规透视组（convFluoro，n=30）。在 38 例患者中，电生理学家选择使用 3D-EAM 进行消融。其中 20 例患者可以在不使用透视的情况下进行消融（零透视）。在最初计划使用 3D-EAM 的 18 例患者中，由于解剖条件困难，需要额外使用透视（转为透视组）。分析手术时间、透视时间和剂量以及并发症。
convFluoro 组和零透视组的手术时间相似（74±24 分钟比 80±26 分钟，p=ns）。转为透视组的手术时间明显长于 convFluoro 组（94±30 分钟比 74±24 分钟，p<0.05）。与 convFluoro 组相比，使用 3D-EAM 显著减少了透视时间（convFluoro 组与转为透视组比较，12±9 分钟比 7±6 分钟，p<0.05）。convFluoro 组与转为透视组的透视剂量差异无统计学意义（169±166 cGycm 比 134±137 cGycm，p=ns）。在零透视组中，完全没有使用辐射。3D-EAM 引导的 RFCA 在所有患者中均取得了主要成功。在不同的组中，总体上只有少数轻微并发症，没有发生重大并发症。
AVNRT 患者的零透视 RFCA 是可行且安全的。3D-EAM 可降低大多数患者的辐射暴露，同时不会延长手术时间或增加并发症。
