AIMS: Interventional cardiology procedures may expose patients and staff to considerable radiation doses. We aimed to assess whether exposure to ionizing radiation during catheter ablation of supraventricular tachycardia (SVT) can be completely avoided. METHODS AND RESULTS: In this prospective randomized study, patients with SVT (atrioventricular re-entrant tachycardia n = 94, typical atrial flutter n = 29) were randomly assigned in a 1:1 ratio to catheter ablation with conventional fluoroscopic guidance (CF group) or with the EnSite Precision mapping system [zerofluoro (ZF) group]. Acute procedural parameters, increased stochastic risk of cancer incidence and 6-month follow-up data were assessed. Between May 2019 and August 2020, 123 patients were enrolled. Clinical parameters were comparable. Median procedural time was 60.0 and 58.0 min, median fluoroscopy time and estimated median effective dose were 240 s vs. 0 and 0.38 mSv vs. 0 and arrhythmia recurrence was 5% and 7.9% in the CF and ZF groups, respectively. The acute success rate was 98.4% in both groups. No procedure-related complications were reported. At an average age of 55.5 years and median radiation exposure of 0.38 mSv, the estimate of increased incidence was approximately 1 in 14 084. The estimated mortality rate was 1 per 17 857 exposed persons. CONCLUSIONS: The procedural safety and efficacy of the zero-fluoroscopic approach are similar to those of conventional fluoroscopy-based ablation for atrioventricular nodal re-entrant tachycardia and atrial flutter. Under the assumption of low radiation dose, the excessive lifetime risk of malignancy in the CF group due to electrophysiology procedure is reasonably small, whilst totally reduced in zero fluoroscopy procedures.
- MeSH
- atrioventrikulární nodální reentry tachykardie * diagnostické zobrazování chirurgie MeSH
- fluoroskopie metody MeSH
- flutter síní * diagnostické zobrazování chirurgie MeSH
- katetrizační ablace * škodlivé účinky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- nodus atrioventricularis MeSH
- prospektivní studie MeSH
- srdeční arytmie chirurgie MeSH
- supraventrikulární tachykardie * diagnostické zobrazování chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: Catheter ablation in the left atrium has become a common therapeutic strategy in the management of atrial fibrillation (AF). The high degree of success and safety profile of this procedure is dependent on precise knowledge of the true anatomy in the chamber. This information is imported mostly from cardiac computed tomography. A novel method for imaging the left atrial anatomy is three-dimensional rotational angiography (3DRA). METHODS: The aim of our study was to the compare clinical outcome and safety of catheter ablation for atrial fibrillation guided by 3DRA vs. conventional CT scan. One hundred and twenty-five patients referred for AF catheter ablation at St. Anne's University Hospital Brno were included in the retrospective analysis of clinical outcome within the first year after the procedure. RESULTS: There was a close correlation in overall procedural parameters between the groups. The frequency of recurrent episodes of AF (24% in CT-guided group vs. 27% in 3DRA-guided group, P=0.721) as well as the onset of atypical atrial flutter after the procedure (10% vs. 8%, respectively, P=0.731) were similar in both groups. No difference in the number of patients necessitating repeat ablation (5% vs. 5%, P=0.984) was found. Procedural complications of ablations guided by 3DRA were comparable with those guided by CT (2% vs. 3%, respectively, P=0.568). CONCLUSION: 3DRA has proven to be a safe and simple method for imaging the left atrium and guiding catheter ablation for AF. This approach is anticipated to become a new standard in 3D reconstruction of the left atrium.
- MeSH
- angiografie metody MeSH
- délka operace MeSH
- fibrilace síní diagnostické zobrazování chirurgie MeSH
- intervenční radiografie metody MeSH
- katetrizační ablace škodlivé účinky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- počítačová rentgenová tomografie metody MeSH
- recidiva MeSH
- srdeční síně diagnostické zobrazování MeSH
- venae pulmonales diagnostické zobrazování MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
Úvod: Katetrová léčba fibrilace síní je běžně používanou léčebnou metodou. Vzhledem k anatomické složitosti levé síně se používají k podpoře výkonu trojrozměrné modely této srdeční dutiny získané z počítačové tomografie (CT). Rotační atriografie je nová zobrazovací metoda sloužící k získání stejných dat, která nám poskytuje CT vyšetření. Metody: Cílem naší práce bylo u 65 pacientů podstupujících ablační výkon pro fibrilaci síní srovnat anatomické parametry levé síně získané metodou 3D rotační atriografie s daty získanými z CT. Dále jsme se zaměřili na porovnání radiační zátěže. Výsledky: Výsledky měření rozměru ústí žil ukázaly dobrou korelaci mezi oběma sledovanými metodami. Při porovnání rozměrů nebyl prokázán statistický rozdíl mezi daty z CT srdce a z 3D rotační atriografie, kromě rozměru levé dolní plicní žily měřeného v předozadní projekci. Byla prokázána statisticky významná redukce radiační zátěže při použití 3D rotační atriografie oproti CT vyšetření (10,2 ± 2,318 vs. 2,3 ± 0,6 mSV mGy-1cm-1, p < 0,001). Závěr: Metoda 3D rotační atriografie levé síně nám poskytuje stejné anatomické informace jako CT srdce. Při použití této nové metody dochází ke statisticky významné redukci radiační zátěže pro pacienta.
Introduction: Catheter ablation therapy for atrial fibrillation is a commonly used therapeutic method. Given the anatomical complexity of the left atrium, three-dimensional models of this chamber of the heart obtained by computed tomography (CT) are employed. Rotational atriography is a new imaging technique used to obtain the same data as those obtained by CT scans. Methods: Our aim was to compare anatomical parameters of the left atrium obtained by the method of 3D rotational atriography with the data obtained by CT scans in 65 patients undergoing ablation therapy for atrial fibrillation. In addition, we aimed at comparing the radiation burden. Results: The results of measurements of the dimensions of venous orifices showed a good correlation between the two methods observed; when comparing the dimensions, no statistical difference was found between the use of data from the CT of the heart and from 3D rotational atriography, except for the dimension of the left inferior pulmonary vein measured in the anteroposterior projection. A statistically significant reduction in the radiation burden was shown with the use of 3D rotational atriography versus CT examination (10.2 ± 2.318 vs. 2.3 ± 0.6 mSV mGy-1cm-1, p < 0.001). Conclusion: The method of 3D rotational atriography of the left atrium provides the same anatomical information as does CT of the heart. With the use of this new method, there is a statistically significant reduction in the radiation burden for the patient.
- MeSH
- ablace MeSH
- angiografie * metody MeSH
- dávka záření MeSH
- fibrilace síní diagnóza radioterapie MeSH
- katétry MeSH
- kontrastní látky MeSH
- lidé MeSH
- obsah radioaktivních látek v organizmu MeSH
- počítačová rentgenová tomografie MeSH
- rotace MeSH
- srdeční síně * anatomie a histologie radiografie MeSH
- statistika jako téma MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Introduction Transseptal puncture is a commonly used method which we can see being applied nowadays predominantly in electrophysiological studies. This interventional method has been very successful at experienced electrophysiological laboratories and has a low risk of potential complications. One of the described complications is emergence of hypotension or bradycardia or transient ST segment elevation on the basis of parasympathetic activation or air embolism into the coronary artery. Patient, methods In the case history we present a substantial response in the context of transseptal puncture during electrophysiological examination with pulmonary vein isolation in a patient with persistent atrial fibrillation. This patient subsequently developed bradycardia and there was no response to atropine so he needed temporary cardiac pacing. Furthermore, a stenocardia was observed, as well as ECG elevations of ST segment in II, III and aVF leads and even in the chest leads, and also a severe hypotension with the need for catecholamine support. Echocardiography examination excluded pericardial effusion, and urgent coronary angiography showed normal findings on coronary arteries. Problems gradually subsided and further course did not require pacing and catecholamine support, and subsequently the performance was completed without any other problems. Discussion and conclusion Literature describes individual cases with signs of ischemia in the inferior wall after the transseptal puncture. It has always been a temporary complication, and often with a decline of problems after intravenous administration of calcium channel blockers or nitrate. It was therefore suspected that this is a transient coronary artery spasm due to irritation of the autonomic nervous system with vagus nerve activation. Prompt administration of atropine, and if the problems persist also administration of norepinephrine, leads to a decline of problems. It becomes apparent that the need for timely treatment of this complication is necessary. After remission of symptoms and at the exclusion of other possible complications it is possible to finish the electrophysiological study.
- Klíčová slova
- elevace úseku ST, elektrofyziologické vyšetření,
- MeSH
- atropin aplikace a dávkování MeSH
- elektrofyziologické techniky kardiologické metody MeSH
- elektrokardiografie MeSH
- fibrilace síní terapie MeSH
- financování organizované MeSH
- hypotenze MeSH
- ischemická choroba srdeční etiologie MeSH
- katetrizační ablace metody MeSH
- koronární angiografie využití MeSH
- lidé středního věku MeSH
- lidé MeSH
- noradrenalin aplikace a dávkování MeSH
- peroperační komplikace farmakoterapie MeSH
- punkce metody MeSH
- srdeční septum chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
