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。
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。
“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，
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
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.”