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Elektromagnetische Interferenzen bei 3-D-Mappingverfahren

Electromagnetic interference in 3D-mapping procedures

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Zusammenfassung

Katheterablationen sind heute ein weit verbreitetes Verfahren zur Behandlung von Herzrhythmusstörungen. Hierfür sind genaue anatomische Kenntnisse sowohl im Vorfeld als auch während der Untersuchung erforderlich und eine wichtige Voraussetzung zur zielgerichteten Behandlung. Während zu Beginn der Ära von katheterinterventionellen Behandlungen die Fluoroskopie das einzige und gängige Visualisierungsmittel war, sind seit Mitte der 1990er Jahre kontinuierlich 3‑D-Mappingssysteme zur nichtfluoroskopischen Untersuchung von Patienten (weiter)entwickelt worden. Die sachgemäße Anwendung dieser 3‑D-Systeme, die Katheter nichtfluoroskopisch visualisieren und Arrhythmiemechanismen meist sehr detailliert identifizieren, leistet heute einen bedeutsamen Beitrag zur erfolgreichen katheterinterventionellen Behandlung von Rhythmusstörungen. Vor allem Patienten mit ventrikulären Arrhythmien sind jedoch nicht selten Träger elektronischer Devices wie Defibrillatoren oder teilweise hämodynamischen Unterstützungssystemen. Implantierbare Devices führen zu elektromagnetischen Interferenzen, die die Diagnostik und Behandlung im Rahmen elektrophysiologischen Untersuchungen und Ablationen erschweren können. Dieser Artikel diskutiert die Widrigkeiten und Erfahrungen in Zusammenhang mit magnetbasierten 3‑D-Systemen sowie implantierbaren elektromagnetisch aktiven „cardiac devices“.

Abstract

Catheter-based ablation is nowadays a safe and widespread procedure for the treatment of cardiac arrhythmia. This requires exact anatomical knowledge both before and during the examination and is an important prerequisite for targeted treatment. At the beginning of the era of interventional catheter-based treatment, fluoroscopy was the only and usual means of visualization, whereas in the middle of the 1990s continuous 3D-mapping systems were developed for the non-fluoroscopic examination of patients. The correct use of these 3‑D systems, which non-fluoroscopically visualize the catheter and mostly identify mechanisms of arrhythmia in great detail, nowadays makes an important contribution to successful interventional catheter treatment of arrhythmia; however, it is not uncommon for patients with ventricular arrhythmia to also carry implanted electronic devices, such as pacemakers, defibrillators or less frequently left ventricular hemodynamic support systems. All implantable devices lead to electromagnetic interferences, which can complicate the diagnostics and treatment during electrophysiological examinations and ablation. This article addresses the adversities and experiences associated with magnet-based 3D systems and implantable electromagnetically active cardiac devices.

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Authors and Affiliations

  1. Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland

    Fatih Güner, Patrick Leitz, Christian Ellermann, Julia Köbe, Philipp S. Lange, Julian Wolfes, Benjamin Rath, Florian Doldi, Kevin Willy, Gerrit Frommeyer & Lars Eckardt

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  1. Fatih Güner
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Correspondence to Fatih Güner.

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Interessenkonflikt

F. Güner, P. Leitz, C. Ellermann, J. Köbe, P.S. Lange, J. Wolfes, B. Rath, F. Doldi, K. Willy, G. Frommeyer und L. Eckardt geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Güner, F., Leitz, P., Ellermann, C. et al. Elektromagnetische Interferenzen bei 3-D-Mappingverfahren. Herzschr Elektrophys 33, 290–296 (2022). https://doi.org/10.1007/s00399-022-00883-7

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  • DOI: https://doi.org/10.1007/s00399-022-00883-7

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