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.

Katheterablation - Strahlenrisiko - Anpresskraftkontrolle - AV-Knoten-Reentrytachykardie

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

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