零射线下导管消融右室流出道室性早搏的有效性及安全性

发布时间：2018-04-23 05:16

本文选题：零射线 + 右室流出道　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景室性早搏(premature ventricular contractionsPVCs)是一种异位搏动介导的电活动,可来源于心房外的心脏其他组织结构。在无结构性心脏病的特发性PVCs中,PVCs来源主要来自右室流出道,而多数结构性心脏病来源于左心室[1]。PVCs可发生于正常人,随着年龄增长,发病率增高,45-65岁无结构性心脏病人群中发生率达6%[2],正常人群中PVCsHolter检出率1.3%-20%[3]。PVCs临床表现变异性很大,最常见为心悸、心慌感,严重者可触发恶性心律失常引起黑蒙、晕厥、猝死。近来研究发现频发PVCs有潜在引起左心功能不全及扩张性心肌病危险[4-9],导管导管射频消融术(Radio Frequency Catheter Ablation RFCA)能成功逆转PVCs相关的心肌病。但传统RFCA中的存在放射损伤,三维电解剖标测系统指导下的RFCA能最大程度减少术中X线的暴露,且手术更加安全精准高效,有的甚至能达到零射线下完成手术。目的通过与常规X线指导对比,评估Carto3三维电解剖标测系统指导下零射线导管射频消融治疗特发性右室流出道PVCs(premature ventricular contractions from the right ventricular outflow tract,RVOT-PVCs)的有效性及安全性。方法分析收治的RVOT-PVCs拟行导管射频消融治疗的患者46例,其中三维组21例,其中男9例(43%),女12例(57%),平均年龄(41.7±14.0)岁,运用Carto3系统重建右室流出道模型并指导标测及消融;常规组25例,其中男8例(32%),女17例(68%),平均年龄(41.2±11.5)岁,仅在传统X线指导下行标测和消融。比较两组标测时间、放电次数、手术即时成功率、手术时间、X线曝光时间的差异,并比较远期成功率及并发症发生率的差异,并将结果做统计学分析。结果两组患者即时成功率三维组(95.2%)vs.常规组(92.0%),P0.05,差异无统计学意义。与常规组相比,三维组标测时间明显缩短(3.5±0.8)min vs.(6.6±2.7)min,P0.01;放电次数明显减少(4.6±1.0)次vs.(8.7±2.5)次,P0.01;手术时间明显缩短(61.1±9.7)min vs.(80.7±34.2)min,P0.05;三维组术中完全零射线,而常规组X线曝光时间为(16.5±8.4)min。随访(15±9)个月,远期成功率三维组90.5%,常规组88.0%,P0.05,差异无统计学意义。三维组无手术相关并发症发生,常规组发生1例心包填塞,经心包穿刺置管引流后恢复。结论Carto3三维电解剖标测系统指导下行零射线导管射频消融治疗特发性右室流出道PVCs安全、有效,可较传统X线指导消融明显缩短标测时间、放电次数及手术时间,并可显著减少射线暴露甚至零射线。
[Abstract]:Background VPB premature ventricular contractionsPVCsis an ectopic pulsatile mediated electrical activity, which can be derived from other cardiac structures outside the atrium. In idiopathic PVCs without structural heart disease, the origin of PVCs mainly comes from the right ventricular outflow tract, while most of the structural heart disease comes from the left ventricle [1] .PVCs may occur in normal persons, with age, The incidence of non-structural heart disease was 6% (2). The prevalence rate of PVCsHolter was 1.3-20% [3]. The most common clinical manifestations were palpitation, palpitation, palpitation, severe arrhythmia, which could lead to black Mongolia, syncope and sudden death. Recent studies have found that frequent PVCs has the potential to cause left ventricular dysfunction and dilated cardiomyopathy [4-9]. Radio Frequency Catheter Ablation RFCA can successfully reverse PVCs related cardiomyopathy. But there is radiation injury in traditional RFCA. RFCA under the guidance of three-dimensional electroanatomy mapping system can minimize the exposure of X-ray in operation, and the operation is more safe, accurate and efficient, and some can even complete the operation under zero ray. Objective to evaluate the efficacy and safety of radiofrequency ablation of PVCs(premature ventricular contractions from the right ventricular outflow tractorius (RVOT-PVCs) guided by Carto3 three-dimensional electroanatomic mapping system in the treatment of idiopathic right ventricular outflow tract (RVO). Methods A total of 46 patients with RVOT-PVCs undergoing radiofrequency catheter ablation were analyzed, including 21 patients in three-dimensional group (9 males and 12 females with mean age of 41.7 卤14.0). The right ventricular outflow tract model was reconstructed with Carto3 system and the mapping and ablation were guided. There were 25 cases in the routine group, of which 8 cases were males and 17 cases were females, with an average age of 41.2 卤11.5 years. To compare the difference between the two groups in measuring time, discharge times, immediate success rate of operation and X-ray exposure time, the difference of long-term success rate and complication rate was compared, and the results were analyzed statistically. Results the instant success rate of the two groups was 95. 2% vs. In the routine group, there was no significant difference between the two groups (P 0.05). Compared with the routine group, the mapping time in the 3D group was significantly shortened by 3.5 卤0.8)min vs.(6.6 卤2.7 min P0.01, the discharge times were significantly reduced by 4.6 卤1.0 times, the vs.(8.7 卤2.5 times, the operative time was significantly shortened by 61.1 卤9.7)min vs.(80.7 卤34.2 min P 0.05, and the X-ray exposure time was 16.5 卤8.4 min in the 3D group. Follow-up for 15 卤9 months showed that the long-term success rate was 90.5 in the 3D group and 88.0 in the routine group (P0.05). There was no significant difference between the two groups. In the three dimensional group, there were no complications associated with operation, while in the routine group, 1 case had pericardial tamponade and recovered after drainage by pericardial puncture. Conclusion the radiofrequency catheter ablation under the guidance of Carto3 three-dimensional electroanatomic mapping system is safe and effective in the treatment of idiopathic right ventricular outflow tract (PVCs). It can significantly shorten the mapping time, discharge times and operation time compared with conventional X-ray ablation. And can significantly reduce radiation exposure or even zero-ray.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7

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