评估三维电磁导管标测系统指导局灶性房性快速心律失常射频消融的临床价值  

Electroanatomical mapping Carto system to guide radiofrequency catheter ablation of atrial tachycardia: clinical value

作　　者：舒茂琴[1] 冉擘力[1] 宋治远[1] 钟理[1] 冯媛媛[1] 李永华[1] 涂爱华[1] 仝识非[1] 庄国强[1] 

机构地区：[1]第三军医大学西南医院心血管内科,重庆市介入心脏病学研究所,重庆400038

出　　处：《第三军医大学学报》2009年第18期1798-1801,共4页Journal of Third Military Medical University

摘　　要：目的探讨三维电磁导管标测系统(Carto)指导导管射频消融治疗局灶性房性快速心律失常(简称房速)的临床价值。方法我院2007年4月至2009年4月共13例房速患者接受治疗,男性7例,女性6例,年龄(42.2±10.2)岁,其中3例为常规消融失败患者。对所有患者应用Carto标测实时重建房速发作时三维电激动图,判断房速起源部位及类型,采用冷盐水灌注导管在最早激动点或关键峡部消融。结果13例房速均为局灶性房速,12例消融成功,1例右心耳体部房速消融失败。7例房速在希氏束或冠状静脉窦(CS)近端记录到显著提前的A波,电解剖标测和消融证实房速起源于上腔静脉口部3例、右心耳体部1例、CS口部及其附近3例。3例房速在CS电极远端记录到明显提前的A波,消融结果证实房速起源于左心耳后壁1例、左上肺静脉开口部2例。3例房速在希氏束和CS近端记录到相对提前的A波,消融证实房速起源于右下肺静脉口部2例、主动脉无冠窦内1例。随访2～24个月,其中1例术后3周复发,再次消融成功。3例术前显著右心扩大者,术后3个月内2例心脏大小恢复正常,1例心脏无显著变化。结论Carto标测房速起源及类型准确快速,能安全、有效指导消融,提高成功率,特别对常规方法消融失败者很有帮助。Objective To evaluate the clinical value of the electroanatomical mapping Carto system in the guiding of radiofrequeney ablation of atrial taehycardia （AT）. Methods Totally 13 AT patients, 7 males and 6 females at the age of （42.2± 10.2） , including 3 patients failed in conventional radiofrequeney ablation, who received the therapy from April 2007 to April 2009 in our hospital were studied. Three dimensional eleetroanatomical maps were constructed in the left or right atrium using electroanatomieal mapping system （Carto）. The type of AT （focal or maero reentrant） was identified by the eleetroanatomieal maps, and the ablation targets were at the earliest activation sites or the isthmus of circuit. Results （1） All 13 patients were confirmed as focal ATs, and 12 focal ATs were ablated successfully at the earliest activation sites, and one AT of right atria appendage was failed in ablation. The significant early A waves in 7 eases were recorded in His bundle or proximal part of eoronary sinus catheter, and the activation maps demonstrated that the earliest activation sites were at the ostium of superior vena eava （n = 3）, the ostium and the vieinity of coronary sinus （n = 3） and ostia of right atria appendage （ n = 1 ） respectively. （2）The significant early A waves in 3 eases were recorded in the distal part of coronary sinus catheter, and the activation maps demonstrated that the earliest activation sites were at the ostium of left superior pulmonary vein （ n = 2）, and the posterior wall of left atria appendage （ n = 1 ）. （3） The relatively early A waves in 3 eases were recorded in tbe distal part of eoronary sinus, and the activation maps demonstrated that the earliest activation sites were at the ostium of right inferior pulmonary vein （ n = 2）, and the noncoronary sinus of aorta （ n = 1 ）. One complication of pericardial fluid occurred. During a follow-up period of 2 to 24 months, 1 patient with focal AT reeurred and underwent another ablation with sueeessf

关 键 词：房性心动过速 三维电磁导管标测系统 导管消融 

分 类 号：R197.39[医药卫生—卫生事业管理] R454.1[医药卫生—公共卫生与预防医学]