特发性室性心动过速12例的电磁解剖标测系统标测和消融  

Mapping and ablation for idiopathic ventricular tachycardia under Carto system

作　　者：方咸宏[1] 吴书林[1] 杨平珍[1] 李海杰[1] 陈泗林[1] 詹贤章[1] 林纯莹[1] 钱卫民[1] 

机构地区：[1]广东省心血管病研究所心内科,广州510100

出　　处：《岭南心血管病杂志》2005年第3期149-151,共3页South China Journal of Cardiovascular Diseases

摘　　要：目的评价电磁解剖标测系统(Carto)标测和指导射频消融在治疗特发性室性心动过速的临床应用价值。方法入选12例特发性室性心动过速患者,年龄(33±12)岁。心动过速周期(370±95)ms。室性心动过速持续发作时,7FNavi-Star在相关心室标测,实时重建心腔三维电解剖图,右心室室性心动过速在右心室流出道详细标测,根据激动图上最红色区域为较早激动部位,结合大头导管记录心室波最早、且起搏时体表12导联图形与心动过速一致处,作为消融靶点。左心室室性心动过速在间隔部细标,标识较体表QRS波及His束电位提前的P电位处,作为靶点。温控60℃放电消融。以基础态及静脉滴注异丙肾上腺素反复电生理检查.不可诱发室性心动过速作为成功消融终点。结果12例均成功消融,其中右心室室性心动过速7例,均位于右心室流出道前中间隔部,左心室室性心动过速5例,起源于左心室后中间隔4例、中下间隔近心尖部1例。1例左心室室性心动过速于心动过速在左心室后中间隔处标测时,室性心动过速终止,后标志此处作为靶点,放电消融成功。手术时间为(102±25)分钟,曝光时间为(11±7)分钟。随访6～18个月,无复发病例。结论Carto系统通过磁场标测定位,结合心内电图重建室性心动过速时心室电激动图,可有效快速寻找最早激动点或P电位处作为消融靶点,进行电解剖标测,并可在标测导管机械损伤终止室性心动过速处标志,结合起搏标测,作消融参考点指导消融,治疗特发性室性心动过速安全有效。Objedtives To use Carto system to map and ablation for idiopathic ventricular tachycardia (IVT) and assess the clinical value of this new innovation tool. Methods Twelve patients (aged 33±12 years) with IVT were included. No patient had organic heart disease. The cycle length was (370±95 )ms.During going tachycardia,7F Navi-Star mapping catheter was introduced into the interested ventricle,a real-time threedimensional electroanatomical map was constructed according to its intracardiac electrogram and orientation. 'Hot and cold' approach was used, the earliest activation site was targeted for ablation with pre-selected temperature 60℃, and/or combined with conventional pacemapping method. Results All 12 patients had successful ablation. 7 cases were right IVT, the foci of origin were at mid-anterior septum in right ventricular outflow tract. 4 cases were left IVT originated from mid-septum. One case was left IVT near the apex. The procedure time was (102±25) min, the fluoroscopic time was (11±7) min. No recurrences were observed after follow-up of 6-18 months. Conclusions The study demonstrates that the Carto system is useful for electroanatomical mapping and ablation of IVT. Less fluoroscopic time has been needed. Through mapping the interested area in detail, the arrhythmaia focus is identified and ablated quickly and accurately.

关 键 词：特发性室性心动过速 电磁解剖标测系统 电解剖标测 导管射频消融 

分 类 号：R541.71[医药卫生—心血管疾病]