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首页> 外文期刊>JACC. Cardiovascular imaging. >Feasibility and acute efficacy of radiofrequency ablation of cavotricuspid isthmus-dependent atrial flutter guided by real-time 3D TEE.
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Feasibility and acute efficacy of radiofrequency ablation of cavotricuspid isthmus-dependent atrial flutter guided by real-time 3D TEE.

机译：实时3D TEE引导射频消融左室地峡依赖的心房扑动的可行性和急性疗效。

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OBJECTIVES: The aim of this study was to evaluate the feasibility and acute efficacy of real-time 3-dimensional transesophageal echocardiography (RT3DTEE)-guided ablation of the cavotricuspid isthmus (CVTI). BACKGROUND: The use of RT3DTEE to guide a transcatheter radiofrequency ablation procedure has never been systematically investigated. METHODS: Seventy consecutive patients with CVTI-dependent atrial flutter underwent CVTI ablation. Procedural monitoring using RT3DTEE was assigned to patients who requested general anesthesia for the procedure (n = 21 [30%]). In the other 49 patients (the control group), the procedures were monitored using the standard fluoroscopic approach. Procedural time was considered as skin-to-skin electrophysiological procedure duration, not including anesthesia preparation; adequate radiofrequency ablation applications (with fixed temperature and power settings) were considered as lesions lasting >/= 60 s. RESULTS: RT3DTEE allowed visualization of the CVTI and identified related structures in most patients (20 of 21); anatomic features such as long CVTI (n = 11), prominent Eustachian ridge (n = 9), prominent Eustachian valve (n = 6), septal recess (n = 8), and pectinate muscles (n = 10) were frequent. Also, RT3DTEE allowed continuous visualization of ablation catheter movement and contact. Compared with the control group, RT3DTEE was equally effective in achieving CVTI bidirectional block (100% in both groups), and no complications occurred. RT3DTEE shortened procedural time (median 73.0 min, interquartile range [IQR] 60.0 to 90.0 min, vs. median 115.0 min, IQR 85.0 to 133.0 min, p < 0.001), reduced radiation exposure (median fluoroscopy time 4.2 min, IQR 3.1 to 8.4 min, vs. median 19.3 min, IQR 12.9 to 36.4 min, p < 0.001; median fluoroscopy dose 575.4 cGy . cm(2), IQR 428.5 to 1,299.4 cGy . cm(2), vs. median 3,520.7 cGy . cm(2), IQR 1,700.0 to 6,709.0 cGy . cm(2), p < 0.001), and reduced the number of radiofrequency applications to achieve bidirectional block (median 7, IQR 6 to 10, vs. median 12, IQR 10 to 22, p = 0.007). A strong learning curve was detected by comparing procedural data between the first and last patients treated using RT3DTEE. CONCLUSIONS: RT3DTEE-guided ablation of CVTI was feasible, allowing real-time detailed morphological CVTI characterization as well as continuous visualization of the ablation catheter during radiofrequency ablation. This approach entailed marked reductions in procedural time, radiation exposure, and the number of radiofrequency applications.
机译：目的：本研究的目的是评估实时3维经食管超声心动图（RT3DTEE）引导的左室窦峡部切除术（CVTI）的可行性和急性疗效。背景：RT3DTEE引导导管射频消融术的应用从未得到系统的研究。方法：连续70例CVTI依赖性房扑患者接受了CVTI消融。使用RT3DTEE进行程序监视的患者分配给了需要进行全身麻醉的患者（n = 21 [30％]）。在其他49名患者（对照组）中，使用标准的荧光检查方法对手术进行监测。手术时间被认为是皮肤到皮肤的电生理过程的持续时间，不包括麻醉准备;病灶持续> / = 60 s被认为是适当的射频消融应用（具有固定的温度和功率设置）。结果：RT3DTEE可以可视化CVTI并确定了大多数患者的相关结构（21个中的20个）;常见的解剖特征包括长CVTI（n = 11），突出的咽鼓（n = 9），突出的咽鼓管瓣（n = 6），隔中隐窝（n = 8）和果胶状肌肉（n = 10）。此外，RT3DTEE允许连续观察消融导管的运动和接触。与对照组相比，RT3DTEE在实现CVTI双向阻断方面同样有效（两组均为100％），并且没有发生并发症。 RT3DTEE缩短了手术时间（中位73.0分钟，四分位间距[IQR] 60.0至90.0分钟，中位115.0分钟，IQR 85.0至133.0分钟，p <0.001），减少了放射线照射（中位透视时间4.2分钟，IQR 3.1至8.4）分钟，vs。中位数19.3分钟，IQR 12.9至36.4分钟，p <0.001;透视中位剂量575.4 cGy。cm（2），IQR 428.5至1,299.4 cGy。cm（2），vs中位数3,520.7 cGy。cm（2） ，IQR 1,700.0至6,709.0 cGy。cm（2），p <0.001），并减少了实现双向阻滞的射频应用次数（中位数7，IQR 6至10，中位数12，IQR 10至22，p = 0.007） ）。通过比较使用RT3DTEE治疗的第一位和最后一位患者的手术数据，可以检测到很强的学习曲线。结论：RT3DTEE引导的CVTI消融是可行的，可以实时详细地描述CVTI形态，并在射频消融期间连续显示消融导管。这种方法需要显着减少程序时间，辐射暴露和射频应用数量。

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