A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation.
A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation.
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一项随机的前瞻性机械性心脏磁共振研究将导管稳定性，晚期增强和3年的临床结果与机器人辅助与标准导管消融相关联。
DOI：
10.1093/europace/euu364
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发表时间：
2015-08
期刊：
影响因子：
--
通讯作者：
Gill JS
中科院分区：
文献类型：
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作者：
Arujuna A;Karim R;Zarinabad N;Gill J;Rhode K;Schaeffter T;Wright M;Rinaldi CA;Cooklin M;Razavi R;O'Neill MD;Gill JS
前瞻性比较标准与机器人辅助导管消融病变产生的心脏磁共振晚期钆增强（LGE）结果，并将其与临床结局相关联。40例接受首次左心房消融术的阵发性房颤患者（平均年龄54 ± 13.8岁）随机接受机器人辅助导航（汉森Sensei® X）或标准导航。采用LGE和T2 W成像序列进行术前、急性（术后24小时）和晚期（超过3个月）扫描，并对肺静脉（PV）窦周围的周向增强百分比进行量化。两组的基线术前增强相似。在急性成像中，机器人组中LGE和T2 W信号的平均包围%分别为72%和80%，而标准消融为60%（P = 0.002）和76%（P = 0.45）。在晚期成像中，两组的T2 W信号均恢复至基线水平。晚期钆增强仍然是主要信号，机器人组中有56%包围，而标准组中有45%包围（P = 0.04）。在6个月随访时，无青光眼患者的平均LGE包围率几乎相似（机器人64%，标准60%，P = 0.45），但在复发时，机器人组的LGE更高（43% vs. 30%，P = 0.001）。在平均3年随访时，机器人组进行了1.3次手术，而标准组为1.9次（P < 0.001），成功率为80% vs. 75%。机器人辅助消融导致肺静脉窦周围的LGE更大。在初始治疗期间，通过改善导管稳定性和贴靠力创建有效损伤可能有助于减少后续重复手术。
To prospectively compare cardiac magnetic resonance late gadolinium enhancement (LGE) findings created by standard vs. robotically assisted catheter ablation lesions and correlate these with clinical outcomes. Forty paroxysmal atrial fibrillation patients (mean age 54 ± 13.8 years) undergoing first left atrial ablation were randomized to either robotic-assisted navigation (Hansen Sensei® X) or standard navigation. Pre-procedural, acute (24 h post-procedure) and late (beyond 3 months) scans were performed with LGE and T2W imaging sequences and percentage circumferential enhancement around the pulmonary vein (PV) antra were quantified. Baseline pre-procedural enhancements were similar in both groups. On acute imaging, mean % encirclements by LGE and T2W signal were 72% and 80% in the robotic group vs. 60% (P = 0.002) and 76%(P = 0.45) for standard ablation. On late imaging, the T2W signal resolved to baseline in both groups. Late gadolinium enhancement remained the predominant signal with 56% encirclement in the robotic group vs. 45% in the standard group (P = 0.04). At 6 months follow-up, arrhythmia-free patients had an almost similar mean LGE encirclement (robotic 64%, standard 60%, P = 0.45) but in recurrences, LGE was higher in the robotic group (43% vs. 30%, P = 0.001). At mean 3 years follow-up, 1.3 procedures were performed in the robotic group compared with 1.9 (P < 0.001) in the standard to achieve a success rate of 80% vs. 75%. Robotically assisted ablation results in greater LGE around the PV antrum. Effective lesions created through improved catheter stability and contact force during initial treatment may have a role in reducing subsequent re-do procedures.