心内超声广泛应用,可以减少导管消融手术的X射线辐射

来自纽约长老会和威尔康奈尔医学研究所的研究人员倡导减少放射线暴露的心房颤动手术
应更广泛地采用心内回波,以减少导管消融的辐射

根据新的评论文章,2017年9月20日 – 导管消融治疗不规则心跳,限制或消除患者暴露于辐射,应由医生更广泛地采用。这篇文章是由纽约长老会和威尔康奈尔医学心脏病学家撰写的,并在6月的“心律”杂志上刊登,之前在线发表。在这种情况下,他们认为,程序广泛使用的主要障碍 – 医生对不同视觉工具的不适 – 可以通过培训和经验克服。

心房颤动(AF)是一种影响多达610万美国人的病症,其特征是由于电脉冲失火引起的不规则,频繁的心率。医生通常使用称为导管消融的微创手术治疗病情,医生将薄而柔软的电线插入静脉,将它们插入心脏。一旦在那里,医生应用射频能量或冻结温度来消除异常的电路径,恢复心脏的正常节律。

为了指导这个过程,许多心脏科医生依靠称为荧光透视的成像技术,其使用连续X射线束来观察心脏。虽然这种技术有效,但该技术将护理团队和患者暴露于高剂量的辐射。

首席作者Bruce Lerman博士说:“患者在常规AF消融手术期间接受的荧光透视检查量估计与患者接受830 X射线照射剂量相当。” 纽约长老会/威尔康奈尔医学中心和威尔康奈尔医学心脏电生理实验室的心脏病学和主任,他也是H. Altschul医学硕士教授。“在我们手中,绝大多数AF患者不需要荧光透视,导致患者或电生理学家无法进行辐射照射。

为了完成无氟导管消融,纽约长老会和威尔康奈尔医学团队使用发射高频声波的技术,称为心内超声心动图(ICE),以创建一个完整而精确的心脏图像。此外,使用计算机化的三维测绘系统和手术前心脏成像可进一步指导手术。威尔康奈尔医学电生理学家认为,全国医师可以通过挑战根深蒂固的做法来接受无纤维性心房颤动消融。

“虽然几年前引入了无氟导管消融的概念,但尚未得到广泛的应用,主要是因为许多电生理学家接受过X射线成像的依赖,不愿相信ICE,”合着者Jim Cheung说, MD,纽约长老会/威尔康奈尔医学中心临床电生理研究和心脏电生理学研究员培训主任,威尔康奈尔医学副教授。张先生是电生理设备制造商Biosense Webster的顾问,并已获得研究金资助。“这个问题可以用经验补救。对于一些人来说,学习曲线可能很陡,但一般来说,技能集可以轻易获得。通过周到地修改程序的执行方式,

“我们正在培训我们的研究员,利用这种技术,努力引导下一代心脏病专家进行氟化物消融。”

“执行无氟导管消融AF最重要的必要条件是愿意放弃旧习惯,”他也是Biosense Webster的顾问。“这样做对于患者和保健专业人员来说都将具有巨大的优势。”

阅读相关文章“电生理学技术的新进展”。
欲了解更多信息:www.heartrhythmjournal.com

以上内容由Google翻译而来,原文如下:

Intracardiac Echo Should be More Widely Adopted to Minimize Radiation in Catheter Ablations

Researchers from NewYork-Presbyterian and Weill Cornell Medicine advocate for atrial fibrillation procedure that reduces radiation exposure

 September 20, 2017 — Catheter ablation to treat an irregular heartbeat, which limits or eliminates patients’ exposure to radiation, should be more widely adopted by physicians, according to a new review article. The article was written by NewYork-Presbyterian and Weill Cornell Medicine cardiologists and published in the June print issue of Heart Rhythm and previously published online. In it, they posit that the primary obstacle to the procedure’s widespread use – physicians’ discomfort with a different visual tool – can be overcome with training and experience.

Atrial fibrillation (AF) is a condition that affects as many as 6.1 million Americans and is characterized by an irregular, often rapid heart rate caused by a misfiring of electrical impulses. Physicians commonly treat the condition using a minimally invasive procedure called catheter ablation, in which doctors insert thin, flexible wires into veins, snaking them up into the heart. Once there, physicians apply radiofrequency energy or freezing temperatures to eliminate the abnormal electrical pathways, restoring the heart’s regular rhythm.

To guide this procedure, many cardiologists rely on an imaging techniquecalled fluoroscopy that uses a continuous X-ray beam to visualize the heart. While effective, the technique exposes both the care team and patient to high doses of radiation.

“The amount of fluoroscopy received by a patient during a routine AF ablation procedure is estimated to be the equivalent of the dose of radiation a patient would receive with 830 X-rays,” said lead author Bruce Lerman, M.D., chief of the Division of Cardiology and director of the Cardiac Electrophysiology Laboratory at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, where he is also the H. Altschul Master Professor of Medicine. “In our hands, the vast majority of AF patients do not require fluoroscopy, resulting in no radiation exposure to the patient or the electrophysiologist performing the procedure.”

To accomplish fluoroless catheter ablation, the NewYork-Presbyterian and Weill Cornell Medicine team use technology that emits high-frequency sound waves, known as intracardiac echocardiography (ICE), to create a complete and precise image of the heart. In addition, the use of computerized three-dimensional mapping systems and pre-procedural cardiac imaging can further guide the procedure. Weill Cornell Medicine electrophysiologists believe that physicians around the country can embrace fluoroless ablation of atrial fibrillation by challenging entrenched practices.

“Although the concept of fluoroless catheter ablation was introduced several years ago, it has yet to gain wide adoption, mostly because many electrophysiologists were trained to rely on X-ray imaging and are reluctant to trust ICE,” said co-author Jim Cheung, M.D., director of clinical electrophysiology research and cardiac electrophysiology fellowship training at NewYork-Presbyterian/Weill Cornell Medical Center and associate professor of medicine at Weill Cornell Medicine. Cheung is a consultant for and has received fellowship grant support from Biosense Webster, a manufacturer of electrophysiology devices. “This concern can be remedied with experience. For some, the learning curve can be steep, but generally, the skill set can be readily acquired. By thoughtfully modifying the way the procedure is performed, we can significantly reduce the radiation risk in the process,” he said.

“We are currently training our fellows to utilize this technique in an effort to guide the next generation of cardiologists to become well-versed in fluoroless ablation,” Cheung said.

“The most critical requisite for performing fluoroless catheter ablation of AF is a willingness to relinquish an old habit,” said Lerman, who is also a consultant for Biosense Webster. “Doing so will have a tremendous advantage for both patients and healthcare professionals.”