Relationship between heart rate on atrioventricular node reentrant tachycardia sustaining and slow path position during procedure of slow path modified ablation using three-dimensional mapping system / 中国介入影像与治疗学

Objective: To observe the relationship between heart rate on atrioventricular node reentrant tachycardia (AVNRT) sustaining and slow path position during procedure of slow path modified ablation using three-dimensional mapping system. Methods: Modified ablation of slow pathway under three-dimensional mapping system was performed in 98 patients with slow-fast (S-F) AVNRT confirmed by invasive electrophysiology examination. The successful target (the site of slow-pathway) and standard His bundle were marked using three-dimensional mapping system, and the distance (Distance A) between the successful target and standard His bundle was measured. The relationship between heart rate in AVNRT and Distance A was analyzed. Results: Distance A was successfully obtained in 96 patients, including 64 tachycardia induced without infusion of isoproterenol, the heart rate was (179.77±29.22)bpm and relevant Distance A was (13.56±5.06)mm, also 32 tachycardia induced with infusion of isoproterenol, the heart rate was (174.91±17.41)bpm and relevant Distance A was (12.43±3.70)mm. No obvious correlation between heart rate and slow path position was found among the above 96 patients (rs=0.048, -0.190; P=0.705, 0.298). Conclusion: There was no obvious correlation between patient's heart rate on AVNRT sustaining and slow path position druing the procedure of slow path modified ablation using three-dimensional mapping system.

Efficacy of Radiofrequency Ablation of Atrial Tachycardia Originating From the Non-coronary Aortic Cusp Guided by Three-dimensional Mapping in 11 Patients / 中国循环杂志

Objectives: To analyze the electrophysiological mapping characteristic and evaluate the effect of radiofrequency ablation in atrial tachycardia (AT) originating from the non-coronary aortic cusp (NCC). Methods: Data from 11 patients with AT originated from NCC and underwent electrophysiological mapping and radiofrequency ablation under the guidance of three-dimensional mapping system were analyzed. The electrical anatomical model of right atrium, His bundle and the root of the aorta was constructed during the procedure to measure the distance between the earliest atrial activation and His bundle. Ablation was performed at the earliest atrial activation site. Results: Cardiac electrophysiological examination evidenced the focal originating of AT in all 11 cases, right atrial activation mapping showed that all the earliest activation site was located in the left or left upper posterior of His bundle, activation time was (21.0 ± 7.9) ms prior to coronary sinus proximal reference wave A, the distance between the earliest activation site and the His bundle was (6.9 ± 3.4) mm. Aortic root mapping showed that the earliest activation sites were all located in the NCC, activation time was (35.0 ± 8.6) ms prior to coronary sinus proximal reference wave A, the distance between the earliest activation site and His bundle was (7.3 ± 4.6) mm. AT in all 11 patients were terminated after ablation, Post ablation, AT could no longer be induced by repeated stimulations. No atrioventricular conduction block occurred during and after operation. No AT recurrences were observed in all 11 patients during the 6 months follow-up. Conclusions: The success rate and safety of three-dimensional mapping guided ablation of AT originated from NCC are high. The main point of the mapping, which is crucial for the successful ablation, is that if the earliest atrial activation site of AT is located at left or left upper posterior of His bundle, it is mandatory to perform aortic root mapping and to routinely determine whether NCC is the earliest activation site of AT.

The application of 3D-reconstruction technique of atrial septum puncture trajectory in radiofrequency catheter ablation for atrial fibrillation / 介入放射学杂志

Objective To evaluate the safety and feasibility of reconstruction technique of atrial septum puncture trajectory with the help of three - dimensional mapping system in performing radiofrequency catheter ablation for atrial fibrillation. Methods Sixty- eight consecutive patients with atrial fibrillation received two times of atrial septum puncture under fluoroscopic guidance to perform radiofrequency catheter ablation. Carto 3, a three - dimensional mapping system, was employed to construct the real time left atrium and pulmonary vein anatomy by using a rapid anatomical mapping (FAM) model. Then, FAM model was used to construct the trajectory, along which the ablation catheter passed from left atrium through the long sheath to the right atrium and finally into the inferior vena cava. The safety and the feasibility of this catheter trajectory, which could allow the catheter repeatedly enter the left atrium, were evaluated. Results By using 3D-reconstruction technique of atrial septum puncture trajectory, the ablation catheter could repeatedly enter the left atrium at right anterior oblique position as well as at left anterior oblique position under zero X-ray fluoroscopy. The average time spent for the procedure was (12. 18±2. 28) seconds. No any complication occurred. Conclusion The reconstruction technique of atrial septum puncture trajectory with the help of three-dimensional mapping system is simple and feasible, the ablation catheter can repeatedly enter the left atrium, the X-ray exposure time spent for catheter ablation of atrial fibrillation can be greatly reduced. (J Intervent Radiol, 2018, 27: 204-206)

Study on the three-dimensional mapping to reduce the X-ray exposure dose of interventional doctors in radiofrequency catheter ablation of atrioventricular nodal reentry tachycardia / 中华劳动卫生职业病杂志

Objective@#To explore the advantage of radiofrequency catheter ablation under the three-dimensional mapping in the treatment of atrioventricular nodal reentrant tachycardia (AVNRT) in reducing the X-ray exposure dose of interventional doctors.@*Methods@#79 patients with AVNRT, in the first hospital of Shanxi Medical University from January 2015 to June 2016, performed to do radiofrequency catheter ablation treatment were selected, and according to the random number method were divided into two-dimensional mapping group and three-dimensional mapping group. The two-dimensional mapping group was mapped the ablation target at the X-ray, while the ablation target was mapped by CARTO 3 system in the three-dimensional mapping group. Compare the X-ray fluoroscopy time, success rate, complications rate and doctor’s X-ray exposure dose between the two groups.@*Results@#Compared with the two-dimensional mapping group, acute success rate and complication rate of the three dimensional mapping group were not statistically significant (P>0.05) , while the X-ray fluoroscopy time and the X-ray dose of the three-dimensional mapping group decreased significantly, the difference was statistically significant (P<0.05) .@*Conclusion@#Three-dimensional mapping can significantly reduce the X-ray irradiation time and interventional doctor’s X-ray exposure dose in radiofrequency catheter ablation of AVNRT patients and the potential hazards of ionizing radiation on the human body.

Vena cava superior izquierda / Left superior vein cava

Mujer de 72 años con fibrilación auricular paroxística ingresó en la sala de electrofisiología para un aislamiento de venas pulmonares. La evaluación inicial con ecocardiografía intracardiaca reveló una dilatación significativa del seno coronario (fig. 1), la cual permitía el libre movimiento del catéter en su interior. De manera interesante, la ubicación del catéter decapolar en la parte lateral del seno generaba un aumento severo del automatismo atrial. Ante la sospecha de una vena cava superior izquierda persistente, se realizó reconstrucción tridimensional (EnSite NavX, St Jude Medical®) logrando visualizar el trayecto de la vena cava superior izquierda en su totalidad y su relación con el seno coronario (fig. 2). Durante el desarrollo embriológico normal, la vena cava superior izquierda involuciona y su trayecto intrapericárdico se convierte en la vena (ligamento) de Marshall. Aunque se ha documentado en aproximadamente el 0,2% de los pacientes llevados a estudio electrofisiológico (convirtiéndola en la alteración de las venas torácicas más común), pasa inadvertida debido a la ausencia de manifestaciones hemodinámicas1. De hecho, la mayoría se diagnostica de manera casual durante exámenes ordenados por otras razones.

EnSite-NavX three-dimensional mapping-guided renal sympathetic denervation: An experimental study / 第二军医大学学报

Objective To explore the safety and efficacy of the renal sympathetic denervation under the guidance of EnSite-NavX three-dimensional mapping system. Methods A three-dimensional model of abdominal aorta and renal artery was constructed under the guidance of EnSite-NavX three-dimensional mapping in 6 healthy Guangxi Bama mini-pigs. Then a radiofrequency ablation catheter was put into the bilateral main trunks of renal artery and six points were marked within each trunk from far to near the heart. One side of the renal artery was ablated and the other received no ablation serving as control. The mini-pigs were followed up for 6 months after the procedure. The norepinephrine (NE) content in the renal tissues was detected by ELISA. Sympathetic nerve damage in the renal tissue of the ablation side was observed by Haematoxylin-Eosin staining. Results Modeling and unilateral renal sympathetic denervation were successfully performed in the six mini-pigs. Subcutaneous hematoma was formed after operation in one pig. None of the pigs had the complications such as renal artery stenosis, thrombopoiesis, or dissection. The NE content of ablation side was significantly lower than that of the opposite side ([170.13±52.60] ng/g vs [429.86±131.43] ng/g, P<0.05). Haematoxylin-Eosin staining showed broken epineurium and loss of axons in the renal sympathetic nerve of the ablation side. Conclusion A three-dimensional model of abdominal aorta and renal artery can be clearly constructed under the guidance of EnSite-NavX three-dimensional mapping. Renal sympathetic denervation can be achieved safely and effectively without fluoroscopy or renal arteriography under the navigation of NavX.

Transcatheter radiofrequency ablation under the guidance of three-dimensional mapping for the treatment of complex cardiac arrhythmias / 介入放射学杂志

Objective To investigate the effectiveness and safety of transcatheter radiofrequency ablation guided by a three-dimensional mapping system (Ensite or Carto) for the treatment of complex cardiac arrhythmias. Methods A cohort of 123 consecutive hospitalized inpatients during the period from February 2006 to December 2008 were selected for this study. These patients suffered from various arrhythmias, including paroxysmal atrial fibrillation (n=58). Persistent or permanent atrial fibrillation (n=10), atrial flutter (n=13), atrial tachycardia (n=12) and ventricular tachycardia or frequent ventricular premature beats (n=30). Transcatheter radiofrequency ablation for arrhythmias was performed under the guidance of an EnSite3 000/NavX or Array mapping system in 80 cases, and under the guidance of a CARTO mapping system in the remaining 43 cases. Results Successful ablation of arrhythmias was obtained by single operation in 106 cases(86.18%). Including 59 cases with atrial fibriUation,11 cases with atrial flutter, 10 cases with atrial tachycardia, and 26 cases with ventricular tachycardia or premature ventricular beat. Ablation procedure was carried out and was successful in 10 cases with a successful rate of 94.31%, including 5 cases with atrial fibrillation. 1 case with recurred atrial flutter, 1 case with recurrent atrial tachycardia, and 3 cases with ventricular tachycardia or premature ventricular beat. After operation, complications occurred in 6 cases, including cardiac tamponade in 4 cases, distal embolism of the left anterior descending coronary artery in 1 case, and pulmonary embolism in 1 case. Conclusion Three-dimensional mapping system can clearly and stereoscopically display the cardiac structures. Therefore, this technique is of great value in guiding the transcatheter radiofrequency ablation for complex arrhythmias, in improving the success rate of ablation and in increasing the safety of the procedure.