RESUMO
Objective:To identify the method to reduce X-ray exposure during ablation of atrial fibrillation (AF) by comparing the cryoballoon (CRYO) ablation and remote magnetic navigation (RMN) ablation.Methods:A retrospective analysis was conducted on 144 patients undergoing CRYO ablation (CRYO group) and 121 patients undergoing RMN ablation (RMN group) in our hospital. Entrance surface doses at reference points online, exposure time during procedure and outcomes were analyzed for different types of patients.Results:Compared with the RMN group, the procedure time for the CRYO group significantly decreased [(165.0±23.6), (97.8±18.4) min, t=26.05, P<0.001]. However, the entrance surface dose value [(232.3±130.7), (669.0±387.5) mGy, Z=-12.29, P<0.001] and X-ray exposure time [(8.1±3.1), (23.4±6.2) min, t=-24.57, P<0.001] increased significantly for the CRYO group. No significant difference was found between the two groups in the proportion of maintaining sinus rhythm during follow-up of patients (71.9%, 75.7%, P=0.618). Multiple regression analysis showed that obese patients, patients with non-paroxysmal AF and patients with variant pulmonary veins were associated with an increase in entrance surface dose values in the CRYO group ( t=5.47, 2.23, 3.39, P<0.05). The X-ray exposure time for the three types patients above in the CRYO group also increased ( t=2.87, 3.86, 3.25, P<0.05) in the CRYO group. However, only obese patients in the RMN group had an increase in entrance surface dose value ( Z=-4.15, P<0.001) and no increase in exposure time. For the three types of patients above, there was no significant difference in proportion of maintaining sinus rhythm between the CRYO group and the RMN group during follow-up ( P>0.05). Conclusions:Compared with RMN ablation, the radiation exposure of CRYO AF ablation significantly increased, especially in obese patients, patients with non-paroxysmal AF and patients with pulmonary veins variation. The use of RMN for these types of patients may reduce the radiation exposure without affecting the procedure outcomes.
RESUMO
Objective· To assess the clinical outcome of catheter ablation guided by remote magnetic navigation(RMN) for ventricular arrhythmias (Vas) including ventricular tachycardia (VT) and ventricular premature complex (PVC) originating from ouflow tract (OT). Methods · A total of 42 patients with idiopathic VT/PVC originated from outflow tract were enrolled. All the patients underwent catheter ablation guided by RMN and 3D Carto mapping system. OT-Vas were divided into two groups:right ventricular outflow tract(RVOT) group and left ventricular outflow tract(LVOT) group. Vas arising from LVOT were mapped and ablated by transaortic retrograde and/or transseptal puncture approaches. The primary study endpoint was acute success rate. The secondary study endpoints were procedure-related parameters, including operator X ray time, ablation time, procedure time and complications. Vas recurrence was detected by Holter electrocardiograph (ECG) which was followed-up at 3 months, 6 months and 1 year after ablation. Results · 74% (31/42) Vas arised from RVOT. 93% (39/42) OT-Vas were achieved acute success. The acute success rate was not different between Vas from RVOT and LVOT (30/31 vs 9/11,P=0.160).Compared to LVOT group,the ablation time and fluoroscopic time of RVOT group were significantly reduced s by 31%(P=0.020) and by 33% (P=0.004). There was no major complication in two groups. Within the 11 cases of LVOT-Vas, 4 LVOT-Vas cases which were ablated by tansaortic retrograde with failure were transferred to transseptal approach and ablated successfully. At one-year follow-up, frequent PVCs recurred in 2 out of 39 patients with acute success. Conclusion · Catheter ablation using RMN for OT-Vas is safe and effective with relatively short operator's X-ray time. For LVOT-Vas, mapping and ablation guided by RMN through transseptal approach can improve the acute success rate.