Tong Yao, Pu Xiaobo, Chen Shi, Chen Chunjia, Chen Yi, Chen Wendong, Gong Aobo, Cao Ying, Fu Hua, Zeng Rui
Department of Cardiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, 400030, China.
Sci Rep. 2024 Dec 28;14(1):31521. doi: 10.1038/s41598-024-83186-w.
Intracardiac echocardiography (ICE) has been used to guide radio-frequency catheter ablation (RFCA) for better catheter navigation and less radiation exposure in treating atrial fibrillation (AF). This retrospective cohort study enrolled 227 AF patients undergoing ICE- or traditional fluoroscopy (TF)-guided RFCA for AF in a tertiary hospital. ICE was used more often in patients with atrial tachycardia [odds ratio (OR) 3.692, p = 0.062], a higher score of Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly (OR 1.541, p = 0.050), or heart failure (OR 2.098, p = 0.156). Based on the comparisons of 47 propensity score-matched pairs from 156 patients only undergoing pulmonary vein isolation (PVI), patients using ICE exhibited a significantly higher success rate in the first transseptal puncture (100% vs. 87.2%, p = 0.041) and less radiation exposure [utilization of radiographic contrast agent (2.7 ml vs. 6.0 ml, p < 0.001), fluoroscopy time (5.7 min vs. 7.6 min, p = 0.026), and fluoroscopy dose (208.4 mGy vs. 332.3 mGy, p = 0.024)] than patients using TF. Other perioperative efficacy outcomes (PVI success, free from AF after RFCA and complications) showed no difference between the matched pairs. ICE can enhance procedural safety and efficiency of RFCA, particularly for more complex patient profiles, in real-world setting.
心内超声心动图（ICE）已被用于指导射频导管消融术（RFCA），以便在治疗心房颤动（AF）时实现更好的导管导航并减少辐射暴露。这项回顾性队列研究纳入了一家三级医院中227例接受ICE或传统荧光透视（TF）引导下AF-RFCA的患者。心房心动过速患者（优势比[OR] 3.692，p = 0.062）、高血压、肾/肝功能异常、中风、出血史或易感性、不稳定的国际标准化比值（INR）、老年人、同时使用药物/酒精（OR 1.541，p = 0.050）或心力衰竭（OR 2.098，p = 0.156）的患者更常使用ICE。基于对仅接受肺静脉隔离（PVI）的156例患者中47对倾向评分匹配对的比较，使用ICE的患者在首次经房间隔穿刺时成功率显著更高（100%对87.2%，p = 0.041），且辐射暴露更少[造影剂使用量（2.7 ml对6.0 ml，p < 0.001）、透视时间（5.7分钟对7.6分钟，p = 0.026）和透视剂量（208.4 mGy对332.3 mGy，p = 0.024）]。其他围手术期疗效结果（PVI成功率、RFCA后无AF及并发症）在匹配对之间无差异。在实际临床环境中，ICE可提高RFCA的手术安全性和效率，尤其是对于更复杂的患者情况。
