Die Anpresskraftkontrolle als Schlüssel zur sicheren strahlenfreien Katheterablation der AV-Knoten-Reentrytachykardie

Zusammenfassung

Hintergrund: Die AV-Knoten-Reentrytachykardie (AVNRT) ist eine häufige supraventrikuläre Herzrhythmusstörung bei Kindern, Jugendlichen und jungen Erwachsenen. Die konventionelle Katheterablation ermöglicht praktisch immer eine endgültige Heilung, ist jedoch mit einer Röntgenstrahlen-Exposition und einem damit verbundenen Strahlenrisiko für Patient und Personal verbunden. Wir beschreiben eine sichere und einfache Technik für eine vollständig durchleuchtungsfreie Katheterablation.

Patienten und Methodik: Bei 12 Patienten mit AVNRT (medianes Alter 20 Jahre; 11–75 Jahre) wurde eine durchleuchtungsfreie Katheterablation angestrebt. Die Visualisierung kardiovaskulärer Strukturen erfolgte unter Zuhilfenahme eines 7F-Ablationskatheters mit integriertem Anpresskraftsensor und eines elektroanatomischen nicht-fluoroskopischen Navigationsystems.

Ergebnisse: Bei allen Patienten gelang eine erfolgreiche, komplikationslose und vollständig durchleuchtungsfreie Katheterablation der AVNRT. Im Nachbeobachtungszeitraum von im Median 6,2 Monaten (2,7–12,8 Monate) traten keine Tachykardie-Rezidive auf.

Folgerung: Die Verwendung eines Ablationskatheters mit Anpresskraftmessung in Verbindung mit einem nicht-fluoroskopischen Navigationssystem erlaubt eine durchleuchtungsfreie Katheterablation der AVNRT. Diese Technik ist einfach und sicher, sodass sie in den meisten elektrophysiologischen Laboren verwendet werden könnte.

Abstract

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is a frequent supraventricular tachycardia in children and young adults. Despite favourable success rates of catheter ablation, conventional fluoroscopic catheter guidance is associated with risks of low-dose ionizing radiation for the patient and the personnel. Here we describe a technique for zero-fluoroscopy catheter ablation using contact force technology.

Patients and methods: Zero-fluoroscopy catheter ablation was attempted in 12 patients with AVNRT (median age 20 years; range 11-75 years). An ablation catheter with integrated contact force sensor and a nonfluoroscopic electroanatomical mapping system was used for visualization of cardiovascular structures. Mean contact forces during mapping and ablation were restricted to an upper limit of 50 g to avoid cardiovascular injuries.

Results: Zero-fluoroscopy catheter ablation was performed successfully and uneventfully in all patients. There were no arrhythmia recurrences during a median follow-up of 6.2 months (range 2.7-12.8).

Conclusion: Zero-fluoroscopy catheter ablation of AVNRT is possible and appears simple yet safe, when a nonfluoroscopic electroanatomical mapping system is used in combination with an ablation catheter with integrated contact force sensor. The presented technique could thus be easily employed in most electrophysiological laboratories.

Schlüsselwörter

Katheterablation - Strahlenrisiko - Anpresskraftkontrolle - AV-Knoten-Reentrytachykardie

Keywords

Catheter ablation - radiation risk - contact force control - atrioventricular nodal reentrant tachycardia

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