磁导航指导下治疗流出道室性心律失常的消融技巧与临床结果分析

发布时间：2018-11-11 21:58

【摘要】：目的·探讨磁导航指导下导管消融治疗流出道起源的特发性室性心律失常(VAs)包括室性心动过速(VT)/室性早搏(PVC)的技巧与临床结果。方法·研究共纳入流出道起源的特发性VAs患者42例,磁导航结合Carto三维电解剖标测系统指导下行导管消融。流出道VAs分2组:左心室流出道(LVOT)组和右心室流出道(RVOT)组。LVOT起源VAs采用主动脉逆行或房间隔穿刺法行标测和消融。主要研究终点为急性手术成功率;次要研究终点为手术相关参数,包括术者X线暴露时间、消融时间、手术时间和手术相关并发症。术后3个月、6个月、1年随访动态心电图,观察VAs复发情况。结果·42例流出道VAs中,31例(74%)源自RVOT。39例(93%)流出道VAs获得急性手术成功,RVOT组与LVOT组之间的急性手术成功率比较,差异无统计学意义(30/31 vs 9/11,P=0.160)。与LVOT组比较;RVOT组的手术时间与术者X线暴露时间分别降低31%(P=0.020)和33%(P=0.004)。2组间均无心包填塞、急性心肌梗死等严重并发症。11例LVOT起源VAs患者中,4例经主动脉逆行消融失败后改用穿间隔法进行消融,均获得成功。39例急性手术成功患者1年随访期内,共2例患者复发。结论·磁导航结合Carto标测系统指导的流出道VAs消融术安全、有效,并有相对较短的术者X线暴露时间;对于LVOT起源VAs,磁导航指导的穿间隔法行标测和消融有助于提高手术成功率。
[Abstract]:Objective to investigate the technique and clinical results of magnetic navigation guided catheter ablation in the treatment of idiopathic ventricular arrhythmias (VAs) with outflow tract origin, including ventricular tachycardia (VT) / ventricular premature beat (PVC). Methods A total of 42 patients with idiopathic VAs with origination of outflow tract were studied. The catheter ablation was guided by magnetic navigation and Carto three-dimensional electroanatomic mapping system. VAs of outflow tract was divided into two groups: left ventricular outflow tract (LVOT) group and right ventricular outflow tract (RVOT) group. LVOT origin VAs was mapped and ablated by retrograde aortic or atrial septal puncture. The main end point of the study was the success rate of acute surgery, and the secondary endpoint was surgical parameters, including X-ray exposure time, ablation time, operative time and surgical complications. Ambulatory electrocardiogram (ECG) was followed up for 3 months, 6 months and 1 year after operation to observe the recurrence of VAs. Results among the 42 cases of outflow tract VAs, 31 cases (74%) originated from RVOT.39 (93%). The success rate of acute operation in RVOT group and LVOT group was not significantly different (30 / 31 vs 9 / 11). P0. 160) Compared with LVOT group; The operative time and X-ray exposure time in RVOT group were decreased by 31% (P0. 020) and 33% (P0. 004), respectively. There were no serious complications such as pericardial tamponade and acute myocardial infarction between the two groups. After retrograde ablation of the aorta, 4 cases were ablated successfully by transcatheter septal ablation, 39 cases of acute successful operation were followed up for 1 year, 2 cases recurred. Conclusion the outflow tract VAs ablation guided by magnetic navigation and Carto mapping system is safe, effective and has relatively short X-ray exposure time. Mapping and ablation of the penetrating septum guided by LVOT origin VAs, magnetic navigation can improve the success rate of the operation.
【作者单位】：上海交通大学医学院附属瑞金医院心脏内科;上海交通大学医学院附属瑞金医院卢湾分院心脏内科;
【基金】：国家自然科学基金(81470450,81470451) 上海交通大学医学院多中心临床研究计划(DLY201604) 上海市教育委员会高峰高原学科建设计划(20161404)~~
【分类号】：R654.2

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