心房颤动冷冻球囊消融与磁导航指导下消融放射暴露对比研究

目的对比分析心房颤动(房颤)冷冻球囊(CRYO)消融术与磁导航(RMN)指导下房颤消融术两种消融方式, 探讨房颤消融术中减少放射暴露的方法。方法回顾性分析本院144例冷冻消融患者(CRYO组)和121例磁导航指导下房颤消融患者(RMN组)术中在线随机参考点累积皮肤表面入射剂量(CD)和X射线照射时间, 分析不同类型患者辐射剂量及手术效果之间的差异。结果与RMN组相比, CRYO组患者的手术时间明显缩短[(165.0±23.6)、(97.8±18.4)min, t=26.05,P<0.001], 但X射线暴露时间明显延长[(8.1±3.1)、(23.4±6.2)min,t=-24.57, P<0.001]、CD值明显增加[(232.3±130.7)、(669.0±387.5)mGy, Z=-12.29,P<0.001]。随访两组患者总体维持窦性心律比例未见明显差异(71.9%、75.7%, P=0.618)。多元回归分析提示, 肥胖患者、非阵发性房颤患者、肺静脉存在变异患者与CRYO组患者CD值增加有关(t=5.47、2.23、3.39, P<0.05), 且CR...

Clinical study of radiation exposure from atrial fibrillation catheter ablation guided by magnetic navigation system and cryoballoon

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.