Tabella 1. Caratteristiche demografiche
EPS, Studio Elettrofisiologico; AVNRT, Tachicardia da Rientro nel Nodo Atrioventricolare; AFl, Flutter Atriale; AT, Tachicardia Atriale
MFA ConvA P N = 88 N =99 Maschi, n (%) 48(54) 50 (50) NS Età (anni) 56±18 50±20 0.06 Pregresse ablazioni, n (%) 3(3) - NS EPS, n (%) 7(8) 48(48) 0.0001 AVNRT, n (%) 29(31) 27(27) NS WPW, n (%) 16(18) 12(12) NS AFl, n (%) 37(42) 12(12) 0.0001 AT, n (%) 1(1) - NS
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Tabella 2. ECG basale e parametri ecografici
EF, Frazione di Eiezione; LA, Atrio Sinistro; LAD, Diametro Atrio Sinistro; LVDd, Diametro Diastolico del Ventricolo Sinistro; LVSd, Diametro Sistolico del Ventricolo Sinistro; Preex, Preeccitazione; SR, Ritmo Sinusale.
MFA ConvA P N = 88 N = 99 ECG basale - SR, n (%) 60 (75) 80 (86) 0.05 - AFl, n (%) 20 (25) 7 (7) 0.02 - Preex, n (%) 9 (11) 11 (12) NS Parametri ECG - PP, ms 750±210 830±155 NS - PR, ms 160±45 158±37 NS - QRS, ms 96±46 92±19 NS - QT, ms 357±55 372±61 NS Inducibilità, n (%) 38(70) 36(48) 0.01 Parametri ecocardio - LAD, mm 39±9 37±9 NS - LA area, cm2 21±8 21±9 NS - LVDd, mm 46±7 48±8 NS - LVSd, mm 30±5 25±5 NS - EF, % 55±10 56±10 NS
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Tabella 3. Dati radiologici
DAP, Prodotto Dose per Area ; ED, Dose Efficace; EPS, Studio Elettrofisiologico ; NA, Non Applicato. MFA ConvA P N = 88 N = 99 Dati Radiologici Raggi Zero, n (%) 51 (58) NA Tempo di fluoroscopia (s) 329±600 810±1100 0.01
Air Kerma, (mGy) 28±92 112±352 <0.05 DAP (Gy*cm2) 3.7±12 13.8±40 <0.05 ED (mSv) 0.8±2.5 3±8.2 <0.05 Dati Procedurali
NvX/Carto, n (%) 71/18(90/10) NA NA Cateteri, n 2.2±0.5 2±0.8 <0.05 Tempo Procedura, (min) 95±36 76±26 <0.05 Tempo di EPS, (min) 27±21 20±15 NS Tempo di geometria, (min) 17±10 NA NA Durata erogazione radiofrequenze (sec) 341±320 178±190 0.01 Applicazioni radiofrequenze, n 9±11 7±10 NS Temperatura catetere, ° C 42±11 43±11 NS Watts erogati 28±6 29±7 NS
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Tabella 4. Dati radiologici per sottogruppi di diagnosi
EPS, Studio Elettrofisiologico; AVNRT, Tachicardia da Rientro nel Nodo Atrioventricolare; AFl, Flutter Atriale; AT, Tachicardia Atriale; DAP, Prodotto Dose per Area ; ED, Dose Efficace.
EPS AVNRT AFl WPW
MFA Conv p MFA Conv p MFA Conv p MFA Conv p
n=7 n=48 n=29 n=27 n=37 n=13 n=16 n=11
Raggi Zero, n (%) 5(71) - 23(79) - 20(51) - 4(25) -
Tempo di fluoroscopia (s) 47±114 163±171 0.05 82±241 1360±1570 0.01 324±560 1930±740 0.006 760±725 1360±540 Ns
Air Kerma, (mGy) 0.5±1.3 6.9±14 0.04 3.8±12 182±420 0.03 49±142 440±740 0.006 35±63 36±15 Ns
DAP (Gy*cm2) 0.08±0.2 0.9±1.9 0.05 0.5±1.6 23±51 0.02 6±17 52±80 0.005 57±29 4.9±1.7 Ns
ED (mSv) 0.02±0.05 0.2±0.4 0.03 0.1±0.3 5.1±10 0.01 1.3±3.6 11±16 0.003 1±1.7 1.3±0.5 Ns
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Tabella 5. Fattori predittivi di conclusione procedura a soli raggi zero. Analisi di regressione logistica univariata e multivariata
AVNRT, Tachicardia da Rientro nel Nodo Atrioventricolare; AFl, Flutter Atriale : WPW, Wolff Parkinson White.
Analisi Univariata Analisi Multivariata
Odds Ratio (95% CI) P
Value Odds Ratio (95% CI) P Value
Età Sesso (maschile) 1.25(0.6-2.5) 0.61 Induzione aritmia 1.6(0.77-3.7) 0.24 AVNRT 1.6(0.84-3.3) 0.1 4.5(1.5-13) 0.008 AFl 2(1-4.1) 0.045 5(1.7-15) 0.003 WPW 2.9(1-7.9) 0.04 1.5(0.3-4.7) 0.7
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Figura 1. Risultati della procedura di ablazione.
In questa immagine vengono riportate in forma grafica le percentuali di successo procedurale, l’insorgenza di complicanze e recidive.
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Figura 2. Dati radiologici: tempo di fluoroscopia.
In questa figura vengono confrontati i tempi di utilizzo della guida fluoroscopica tra 2 gruppi di pazienti a seconda del tipo di diagnosi. EPS, Studio Elettrofisiologico; AVNRT, Tachicardia da Rientro nel Nodo Atrioventricolare; AFl, Flutter Atriale; WPW, Wolff Parkinson White.
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Figura 3. Dati radiologici: dose efficace.
In questa figura vengono confrontati le dosi efficaci di radiazioni tra 2 gruppi di pazienti a seconda del tipo i diagnosi. EPS, Studio Elettrofisiologico; AVNRT,Tachicardia da Rientro nel Nodo Atrioventricolare; AFl, Flutter Atriale; WPW, Wolff Parkinson White.
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Figura 4. Procedure a raggi zero.
Confronto tra numero di procedure eseguite con approccio convenzionale, a minimo uso fluoroscopico e ed esclusivamente a raggi zero, suddividendo per tipo di diagnosi. EPS, Studio Elettrofisiologico; AVNRT, Tachicardia da Rientro nel Nodo Atrioventricolare; AFl, Flutter Atriale; WPW, Wolff Parkinson White.
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Figura 5. Diagramma di dispersione con quartili ricavata dai tempi di fluoroscopia.
La figura rappresenta la curva di apprendimento che si è osservata analizzando i tempi di fluoroscopia nei pazienti sottoposti a mappaggio elettroanatomico. Come mostrato nell'immagine, all'aumentare del numero di procedure diminuisce la durata di utilizzo della guida
fluoroscopica. LCL, Limite inferiore di Confidenza; UCL,Limite superiore di Confidenza; LPL, Limite inferiore di Previsione; UPL,Limite Superiore di Previsione.
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Figura 6. Diagramma di dispersione con quartili ricavata dai tempi di procedura.
La figura rappresenta la curva di apprendimento che si è osservata analizzando i tempi di procedura nei pazienti sottoposti a mappaggio
elettroanatomico. In quest'immagine la diminuzione del tempo di procedura all'aumentare del numero di procedure è solo leggermente accennato. LCL, Limite inferiore di Confidenza; UCL,Limite superiore di Confidenza; LPL, Limite inferiore di Previsione; UPL, Limite Superiore di
Previsione.
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Figura 7. Esempi di procedure ablative guidate dal sistema di mappaggio elettroanatomico Ensite NavX.
In senso orario: (A) Flutter Atriale, (B) Tachicardia da rientro nel NAV, (C) Sindrome WPW con via accessoria in sede antero-laterale destra, (D) Sindrome WPW con via accessoria in sede medio-settale. Nelle immagini si può osservare la codifica-colore applicata alla ricostruzione geometrica ed i punti di interesse o ablazione messi in evidenza.
A B
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