ABSTRACT
PURPOSE: Radiofrequency (RF) catheter ablation of the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT) is highly effective; however, it may require prolonged fluoroscopy and RF time. We postulated that visualization of the SP region with intracardiac echocardiography (ICE) could decrease ablation time, minimize radiation exposure, and facilitate SP ablation compared to the standard, fluoroscopy-guided approach. METHODS: In our study, we randomized 91 patients undergoing electrophysiologic study and SP ablation for AVNRT into 2 groups: fluoroscopy-only (n = 48) or ICE-guided (n = 43) group. Crossover to ICE-guidance was allowed after 8 unsuccessful RF applications. RESULTS: Mapping plus ablation time (mean ± standard deviation: 18.8 ± 16.1 min vs 11.6 ± 15.0 min, p = 0.031), fluoroscopy time (median [interquartile range]: 4.9 [2.93-8.13] min vs. 1.8 [1.2-2.8] min, p < 0.001), and total ablation time (144 [104-196] s vs. 81 [60-159] s, p = 0.001) were significantly shorter in the ICE group. ICE-guidance was associated with reduced radiation exposure (13.2 [8.2-13.4] mGy vs. 3.7 [1.5-5.8] mGy, p < 0.001). The sum of delivered RF energy (3866 [2786-5656] Ws vs. 2283 [1694-4284] Ws, p = 0.002) and number of RF applications (8 [4.25-12.75] vs. 4 [2-7], p = 0.001) were also lower with ICE-guidance. Twelve (25%) patients crossed over to the ICE-guided group. All were treated successfully thereafter with similar number, time, and cumulative energy of RF applications compared to the ICE group. No recurrence occurred during the follow-up. CONCLUSIONS: ICE-guidance during SP ablation significantly reduces mapping and ablation time, radiation exposure, and RF delivery in comparison to fluoroscopy-only procedures. Moreover, early switching to ICE-guided ablation seems to be an optimal choice in challenging cases.
Subject(s)
Catheter Ablation , Tachycardia, Atrioventricular Nodal Reentry , Catheter Ablation/methods , Echocardiography , Electrophysiologic Techniques, Cardiac , Fluoroscopy/methods , Humans , Tachycardia, Atrioventricular Nodal Reentry/diagnostic imaging , Tachycardia, Atrioventricular Nodal Reentry/etiology , Tachycardia, Atrioventricular Nodal Reentry/surgery , Treatment OutcomeABSTRACT
Objective To observe the clinical significance of lung protective ventilation strategy in pa-tients with radiofrequency ablation of atrial fibrillation under general anesthesia through clinical controlled study. Methods Sixty patients undergoing radiofrequency catheter ablation were randomly divided into group L (n=30) and group C(n=30).Breathing parameters were set after tracheal intubation of general anesthesia.Arterial blood gas was collected.PETCO2and airway pressure were recorded during the operation.The operative time,ablation time,flu-oroscopy time and operation-related complications were recorded together with the surgeon satisfaction. Patients were followed up postoperatively for pulmonary complications. The length of patient′s hospital-stay was recorded. Results There was no significant difference in operation time, fluoroscopy time, ablation time and hospitalization days between the two groups (P>0.05). There was no significant difference in the occurrence and grade of PPCs between the two groups (P>0.05). There was significant difference in surgeon satisfaction between the two groups (P<0.01).Conclusion LPVS is suitable for ventilation management in radiofrequency ablation of atrial fibrillation.
