Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping.
Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping.
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DOI：
10.1161/circep.109.872093
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发表时间：
2009-12
期刊：
影响因子：
--
通讯作者：
DiMarco JP
中科院分区：
文献类型：
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作者：
Ferguson JD;Helms A;Mangrum JM;Mahapatra S;Mason P;Bilchick K;McDaniel G;Wiggins D;DiMarco JP
心房颤动的导管消融目前是由x线透视引导的。相关的辐射对患者和医务人员的风险可能很大。我们报告一种心房颤动消融技术，使用心内超声心动图（ICE）和无透视的电解剖定位。21例房颤患者（年龄42 ~ 73岁，男性14例，阵发性14例，持续性7例，体重指数26 ~ 38）行消融术。左锁骨下静脉入路导管，直至所有电极冠状窦电图稳定。两个9F鞘通过导丝经股骨推进至右心房。旋转ICE导管通过可偏转鞘推进。在ICE引导下，电灼辅助下行双隔穿刺。三维MRI左心房图像注册到肺静脉口。导管消融采用ICE和电解剖定位导航。19例未使用透视检查，工作人员未佩戴保护铅。2例使用2 ~ 16分钟透视辅助穿隔穿刺。中位手术时间为208（188 ~ 221）分钟；冠状窦插管5（2 ~ 26）分钟；双隔穿刺耗时26（17 ~ 40）分钟；左房消融时间103（90 ~ 127）分钟。所有患者均行环肺静脉消融，8例患者行左心房消融。无手术相关并发症。无透视的房颤导管消融是可行的，值得进一步关注。这项技术可能特别有助于防止x线暴露在儿童，孕妇和肥胖患者接受左心房消融。
Catheter ablation of atrial fibrillation is currently guided by x-ray fluoroscopy. The associated radiation risk to patients and medical staff may be significant. We report an atrial fibrillation ablation technique using intracardiac echocardiography (ICE) and electroanatomic mapping without fluoroscopy. Twenty-one patients with atrial fibrillation (age, 42 to 73 years; 14 male; 14 paroxysmal, 7 persistent; body mass index, 26 to 38) underwent ablation. A decapolar catheter was advanced through the left subclavian vein until stable coronary sinus electrograms appeared on all electrodes. Two 9F sheaths were advanced transfemorally over a guide wire to the right atrium. A rotational ICE catheter was advanced through a deflectable sheath. Double transseptal puncture was performed with ICE guidance and facilitated by electrocautery. A 3D MRI left atrial image was registered to the ostia of the pulmonary veins using ICE. Catheter ablation was performed using ICE and electroanatomic mapping navigation. In 19 cases, no fluoroscopy was used and the staff did not wear protective lead. In 2 cases, 2 to 16 minutes of fluoroscopy was used to assist transseptal puncture. Median procedure time was 208 (188 to 221) minutes; coronary sinus cannulation took 5 (2 to 26) minutes; double transseptal took 26 (17 to 40) minutes; left atrial ablation time was 103 (90 to 127) minutes. All patients underwent circumferential pulmonary vein ablation and 8 patients underwent additional left atrial ablation. There were no procedure-related complications. Catheter ablation of atrial fibrillation without fluoroscopy is feasible and merits further attention. This technique may be especially helpful in preventing x-ray exposure in children, pregnant women, and obese patients undergoing left atrial ablation.