磁导航遥控射频导管消融治疗房室结折返性心动过速的初步体会

Objective To evaluate the safety and feasibility of remote radiofrequency catheter ablation of atrioventricular nodal reciprocating tachycardia (AVNRT) using the magnetic navigation system (MNS). Methods A total of 37 patients[female 29, mean age (44 ± 15 )years]with documented AVNRT were enrolled in this study from March 2007 to June 2009. A 4 mm tip magnetic mapping and ablation catheter ( Helios Ⅱ ,Stereotaxis, USA),which was remotely controlled by the MNS (Niobe Ⅱ , Stereotaxis, USA), was used for both mapping and ablation. Conventional slow pathway modification with focal ablation at the fight posterior septum was first performed in all patients. If it was failed, linear lesions at the base of Koch' s triangle was then done. Results After ablation, AVNRT was non-inducible in all 37 patients without any complication except one case experienced transient first degree AV block. Focal ablation was performed in 34 patients, and linear ablation strategy was used in the remaining three cases to achieve the end point. Among all the 37 patients, slow pathway ablation was achieved in 14, whereas slow pathway modification was reached in the remaining 23 cases.The mean procedural time, the RF deliveries, the duration of RF application were ( 120 ± 32) min, (2. 9 ± 1.6)times, ( 130 ± 33 )s,respectively. The total fluoroscopy time and the physician X-ray exposure time were(5.3 ±2. 7)min and(2.9 ± 1.1 ) min,respectively. There was no significant change of the AH interval,the HV interval,and the atrioventricular nodal conduction refractory period after ablation. Compared with the first 18 patients, the mean procedural time, the total fluoroscopy time and the X-ray fluoroscopy time during magnetic navigation were significantly decreased in the later 19 patients (P ＜0. 001 ). It indicated that the learning curve of remote catheter ablation using the MNS is short. Conclusion Remote catheter ablation using the MNS to cure AVNRT is safe and effective with short learning curve and decreasing X-ray exposure time for interventional physicians.     

Comparison of remote magnetic versus manual catheter navigation for ablation of atrioventricular nodal reentry tachycardia

Objective The purpose of this study was to compare remote magnetic catheter navigation with manual navigation for the ablation of atrioventricular nodal reentry tachycardia （AVNRT）. Methods From November 2007 to November 2009, 30 consecutive patients with AVNRT received radiofrequency ablation in the Institute of Geriatric Cardiology. Of them, 14 were treated with remote magnetic navigation （RMN） and 16 with manual catheter navigation （MCN）. Total fluoroscopic time,procedure time, procedural success rate, and complication rate were compared between the two groups. Results Total fluoroscopy time and precise orientation time were reduced in RMN group compared to MCN group （7.5＋0.3 min vs 13.9~5.3 rain, and 1.0-x-0.3 min vs 3.2：~0.6 min, respectively, both P〈0.05）. Procedural success rates in both groups were 100% and no AVNRT recurred in all patients during 3 months＇ follow-up. The number of lesions delivered was less for RMN group （3.4~1.1 vs 6.3＋2.2, P〈0.05）. Total procedure time （25.6~7.5 rain vs 27.5a：6.2 rain,/〉〉0.05） was similar between the 2 groups. No procedural complications occurred in both groups. Conclusions RMN for mapping and ablation of AVNRT significantly reduce precise orientation time, total fluoroscopy time and number of lesions delivered compared to the conventional technique of manual steering of deflectable catheters. Remote magnetic control mapping and ablation of AVNRT is more safe and feasible （J Geriatr Cardio12010; 7：7-9）.     

三维电解剖标测指导疑难右侧游离壁旁路的导管消融

Objective To demonstrate the electroanatomic substrates of right-sided free wall (RFW)accessory pathways (APs) which were refractory to conventional catheter ablation utilizing three-dimensional (3D) mapping. Methods Seventeen patients with RFW APs that failed initial conventional catheter ablation(s)by a mean of 1～3(1.8±0.6) attempts were enrolled in the study. Electroanatomic mapping of the right atrium was performed during right ventricular pacing in 14 patients and orthodromic reciprocating tachycardia in 3patients. Radiofrequency energy was delivered via irrigation catheter to the earliest atrial activation site. Results The earliest atrial activation site, which represented the atrial insertion of the APs, was separated from the tricuspid annulus by an average of 9 ～ 20 ( 13.6 ± 3.4 ) mm, and the local activation time was 18 ～ 80(31.5±16.3) ms earlier than that of the corresponding annular point. The target electrogram demonstrated AP potential in fourteen patients and ventriculoatrial fusion in the rest three. Accessory pathway was blocked in one case during moving the catheter and RF ablation delivery on the areas. One patient exhibited an AP with wide branching on the atrial side during mapping. RF ablation with an irrigated catheter successfully interrupted AP conduction in remaining 16 patients without complications. After a mean follow-up of 3 ～ 41 (18.6±12.7) months, there were no recurrences of ventricular preexcitation or episodes of tachycardia. Conclusion RFW APs refractory to conventional catheter ablation might be due to unique anatomic AP features such as more epicardial course at the annulus level with atrial insertion distance from the tricuspid annulus. Electroanatomic mapping is helpful to accurately localize the atrial insertion sites of these APs and facilitates catheter ablation.     

Modified Maze lines plus pulmonary vein isolation created by radiofrequency catheter ablation on the atrial wall to treat atrial fibrillation in elderly

Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Methods After regular electrophysiological study, transseptal punctures were achieved twice with Swartz L1 and R1 sheaths. PV angiographics were conducted to evaluate their orifices and branches. A balloon electrode array catheter with 64 electrodes was put in the middle of the left atrium. Atrium geometry was constructed using Ensite 3000 Navx system. Two RFCA lesion loops and three lines (modified Maze) were created on left and right atrial walls. Each lesion point was ablated for 30 seconds with preset temperature 50 (?)and energy 30W. The disappearance or 80% decrease of the amplitude of target atrial potential and 10 to 20. decrease of ablation impedance were used as an index of effective ablation. Results A total of 11 patients (7 male and 4 female, mean age, 68.7±5.1 years) were enrolled. PAF history was 7.9±4.5 years. PAF could not be prevented by mean 3.1±1.6 antiarrhythmic agents in 6.3±3.4 years. None of the patients had complications with structural heart disease or stroke. Left atrial diameter was 41.3±3.6 mm and LVEF was 59.2±3.7 % on echocardiography. Two loops and three lines were completed with 67.8±13.1 (73-167) lesion points. Altogether 76-168 (89.4±15.3) lesion points were created in each patient. PAF could not be provoked by rapid burst pacing up to 600 beat per minute delivered from paroxysmal coronary sinus electrode pair. Complete PV electrical isolation was confirmed by three-dimensional activation mapping. Mean procedure time was 2.7±0.6 hours and fluoroscopy time was 17.8±9.4 minutes. Patients were discharged with oral aspirin and without antiarrhythmic agents. During follow up of 6.5±1.8 months, seven patients were PAF symptom free (63.6%). PAF attacks were decreased more than 70% in two patients (18.2%). PAF frequency did not change in another two patients (18.2%). Conclusions Ensile 3000 Navx guided modified Maze lines plus PV isolation on the atrial wall is safe and feasible in the elderly palienls. It has the advanlages of exact procedural endpoint, shorter X-ray exposure, fewer complications and salisfied long-term effect PAF control. (J Geriatr Cardiol 2005;2(2): 95-100).     

Feasibility and safety of combined interventional procedures in elderly patients with complex cardiovascular diseases: ex-perience of a single medical center

Objectives: To report the clinical experience of combined interventional procedures in the treatment of elderly patients with coexisting two or more cardiovascular diseases in our medical center, and to assess the feasibility, safety and therapeutic efficacy of this management strategy. Methods: Patients were selected to the study if: 1) age >65 years; 2) with coexistence of two or more cardiovascular diseases which are indications for interventional therapy; 3) patients' general condition and organ functions allow the performance of combined multiple procedures; 4) the predicted procedure time is within 150 min; 5) the predicted contrast medium dosage is within 300 ml. The criteria we analyzed included procedural type, procedural time, fluoroscopy time, dosage of contrast medium, success rates of the procedures, complications and in-hospital mortality. All patients were followed up for 30.4±9.3 months, to determine the all-cause mortality, recurrence rates and adverse cardiac events. Results: From January 2000 to December 2004, combined interventional procedures were performed on 136 patients, with 2 procedures on 134 patients and 3 procedures on 2 patients. The mean procedure time was 115.4±11.6 min, the mean fluoroscopy time was 35.7±9.3 min, and the mean dosage of contrast medium used was 183.6±19.4 ml. Procedural success rate was 100%, no procedure related death or major complications occurred. Conclusion: Performed by a competent team, combined interventional procedures in elderly patients with multiple cardiovascular diseases were feasible and relatively safe.     

递进式消融法治疗持续性心房颤动的初步体会

Objective To evaluate the effect of catheter ablation on persistent atrial fibrillation (AF) using step-wise approach. Methods Thirty-four patients [mean age (54.8 ± 11.4) years] with persistent AF [mean (36.5 ± 9.8) months] underwent catheter ablation were enrolled. Ablation was performed in following sequence. Circumferential ablation of pulmonary veins to achieve isolation, linear ablation of left atrium roof and mitral isthmus, ablation at sites possessing complex fractionated atrial electrograms. Using activation Carto mapping system, if AF converted to atrial flutter (AFL) or atrial tachycardia (AT), then catheter ablation was applied to terminate tachycardia. Results The step-wise ablation approach was successful in rhythm changes (AF converted to AFL/AT) in 88.2% of patients, 61.8% of patients conversion to sinus rhythm directly via ablation. At 12.6 ±6.2 months of follow-up, 82.4% of patients were maintained in sinus rhythm (42.9% of those patients taking oral amiedarone). Conclusion Catheter ablation using step-wise approach is effective in persistent AF treatment.     

递进式消融法治疗持续性心房颤动的初步体会

Objective To evaluate the effect of catheter ablation on persistent atrial fibrillation (AF) using step-wise approach. Methods Thirty-four patients [mean age (54.8 ± 11.4) years] with persistent AF [mean (36.5 ± 9.8) months] underwent catheter ablation were enrolled. Ablation was performed in following sequence. Circumferential ablation of pulmonary veins to achieve isolation, linear ablation of left atrium roof and mitral isthmus, ablation at sites possessing complex fractionated atrial electrograms. Using activation Carto mapping system, if AF converted to atrial flutter (AFL) or atrial tachycardia (AT), then catheter ablation was applied to terminate tachycardia. Results The step-wise ablation approach was successful in rhythm changes (AF converted to AFL/AT) in 88.2% of patients, 61.8% of patients conversion to sinus rhythm directly via ablation. At 12.6 ±6.2 months of follow-up, 82.4% of patients were maintained in sinus rhythm (42.9% of those patients taking oral amiedarone). Conclusion Catheter ablation using step-wise approach is effective in persistent AF treatment.     

递进式消融法治疗持续性心房颤动的初步体会

Objective To evaluate the effect of catheter ablation on persistent atrial fibrillation (AF) using step-wise approach. Methods Thirty-four patients [mean age (54.8 ± 11.4) years] with persistent AF [mean (36.5 ± 9.8) months] underwent catheter ablation were enrolled. Ablation was performed in following sequence. Circumferential ablation of pulmonary veins to achieve isolation, linear ablation of left atrium roof and mitral isthmus, ablation at sites possessing complex fractionated atrial electrograms. Using activation Carto mapping system, if AF converted to atrial flutter (AFL) or atrial tachycardia (AT), then catheter ablation was applied to terminate tachycardia. Results The step-wise ablation approach was successful in rhythm changes (AF converted to AFL/AT) in 88.2% of patients, 61.8% of patients conversion to sinus rhythm directly via ablation. At 12.6 ±6.2 months of follow-up, 82.4% of patients were maintained in sinus rhythm (42.9% of those patients taking oral amiedarone). Conclusion Catheter ablation using step-wise approach is effective in persistent AF treatment.     

递进式消融法治疗持续性心房颤动的初步体会

Objective To evaluate the effect of catheter ablation on persistent atrial fibrillation (AF) using step-wise approach. Methods Thirty-four patients [mean age (54.8 ± 11.4) years] with persistent AF [mean (36.5 ± 9.8) months] underwent catheter ablation were enrolled. Ablation was performed in following sequence. Circumferential ablation of pulmonary veins to achieve isolation, linear ablation of left atrium roof and mitral isthmus, ablation at sites possessing complex fractionated atrial electrograms. Using activation Carto mapping system, if AF converted to atrial flutter (AFL) or atrial tachycardia (AT), then catheter ablation was applied to terminate tachycardia. Results The step-wise ablation approach was successful in rhythm changes (AF converted to AFL/AT) in 88.2% of patients, 61.8% of patients conversion to sinus rhythm directly via ablation. At 12.6 ±6.2 months of follow-up, 82.4% of patients were maintained in sinus rhythm (42.9% of those patients taking oral amiedarone). Conclusion Catheter ablation using step-wise approach is effective in persistent AF treatment.     

递进式消融法治疗持续性心房颤动的初步体会

Objective To evaluate the effect of catheter ablation on persistent atrial fibrillation (AF) using step-wise approach. Methods Thirty-four patients [mean age (54.8 ± 11.4) years] with persistent AF [mean (36.5 ± 9.8) months] underwent catheter ablation were enrolled. Ablation was performed in following sequence. Circumferential ablation of pulmonary veins to achieve isolation, linear ablation of left atrium roof and mitral isthmus, ablation at sites possessing complex fractionated atrial electrograms. Using activation Carto mapping system, if AF converted to atrial flutter (AFL) or atrial tachycardia (AT), then catheter ablation was applied to terminate tachycardia. Results The step-wise ablation approach was successful in rhythm changes (AF converted to AFL/AT) in 88.2% of patients, 61.8% of patients conversion to sinus rhythm directly via ablation. At 12.6 ±6.2 months of follow-up, 82.4% of patients were maintained in sinus rhythm (42.9% of those patients taking oral amiedarone). Conclusion Catheter ablation using step-wise approach is effective in persistent AF treatment.