磁导航指导与手控导管射频消融阵发性房颤的临床对照研究

Remote magnetic versus manual navigation for catheter ablation in paroxysmal atrial fibrillation

目的探讨应用第3代磁导航系统(MNS)指导与常规手控导管射频消融阵发性房颤(PAF)的安全性和有效性。方法入选2014年10月至2016年11月解放军总医院心血管内科收治的PAF患者103例,根据操控射频消融导管的方式,随机分为MNS指导组和手控组。MNS指导组53例,其中男性27例,女性26例,年龄(65±13)岁。手控组50例,其中男性23例,女性27例,年龄(62±15)岁。对比两组间手术时间、消融时间、X线曝光时间及随访3个月复发率。结果 MNS指导组患者53例完成肺静脉隔离52例,手控组患者50例完成肺静脉隔离49例,两组肺静脉隔离率都为98%,差异无统计学意义(P>0.05)。相比手控组,MNS指导组手术时间和消融时间延长,X线曝光时间缩短,差异具有统计学意义(P<0.05)。术后随访患者3个月,MNS组复发10例,手控组复发12例,两组患者复发率差异无统计学意义(19%vs 24%,P>0.05)。结论相比常规手控导管,应用MNS系统可安全有效地用于PAF的标测和消融,并可有效减少X线曝光。

Objective To investigate the safety and efficacy of mapping and ablating paroxysmal atrial fibrillation （PAF） by using remote magnetic navigation system （MNS, Niobe Ⅲ, Stereotaxis） vs manual navigation.Methods Totally 103 consecutive patients diagnosed as PAF in our department from October 2014 to November 2016 were enrolled in our study.They were randomly divided into MNS group [（n=53, 27 males and 26 females, at an age of （65±13） years] and manual navigation group [（n=50, 23 males and 27 females, at an age of （62±15） years].Procedure time, ablation time, X-ray exposure time, and recurrence in 3 months＇ follow-up were collected and compared between the 2 groups.Results Pulmonary vein isolation was accomplished in 52 cases from the MNS group, and in 49 cases of the manual navigation group.The success rate was 98% in both group, without significant difference （P〉0.05）.Compared with the manual navigation group, the MNS group had significantly longer procedure and ablation times, but obviously shorter X-ray exposure time （P〈0.05）.There was no notable difference in the recurrent rate between the MNS （10 cases） and manual navigation groups （12 cases） in 3 months after surgery （19% vs 24%, P〉0.05）.Conclusion In comparison with manual navigation, Niobe Ⅲ remote magnetic navigation system is safe and effective in mapping and ablation of PAF, and it reduces the X-ray exposure time.