应用Carto3电解剖标测系统指导射频消融治疗室性心律失常  

Radiofrequency catheter ablation of ventricular tachyarrhythmia guided by Carto3 system

作　　者：刘天骄[1] 方冬平[1] 郭成军[1] 卢春山[1] 郝蓬[1] 何东方[1] 李果[1] 马克娟[1] 刘冰[1] 张英川[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所,北京100029

出　　处：《中国心脏起搏与心电生理杂志》2013年第2期134-137,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：首发基金资助(项目编号:首发2011-1005-03)

摘　　要：目的报告应用Carto 3电解剖标测系统指导射频消融治疗室性心律失常中的初步体验。方法采用Carto 3与CartoXP系统,以单一专用导管行心室电解剖重建,激动顺序、起搏与拖带标测,实施射频消融。观察消融的即刻成功率、成功靶点的分布、并发症,手术时间及X线曝光时间、随访复发情况。比较Carto 3与CartoXP系统两组数据。结果共入选22例患者,每组各11例,Carto 3组即刻成功11例,成功消融部位:右室流出道间隔部5例,右室流出道游离壁2例,三尖瓣环1例,主动脉二尖瓣连接处1例,左后分支处1例,右室流出道游离壁+左冠窦1例。CartoXP组即刻成功11例,成功消融靶点均位于右室流出道,两组均未见并发症。术后随访1～6个月无1例复发。Carto 3组与CartoXP组比较,手术时间(57±29 min vs 62±10 min,P<0.01)与X线投照时间(5.23±5.42 min vs 8.45±2.33 min,P<0.01)明显缩短。结论应用Carto 3电解剖标测系统可快速重建心脏电解剖结构,提高消融治疗室性心律失常的效率。Objective To study the feasibility, safety and efficacy of 3-dimensional mapping and ablation of ventricular tachyarrhythmia with Carto 3 System. Methods Carto3 or Carto XP system and single catheter were used to reconstruct 3-dimensional ventricular geometry, to perform activation mapping, pacing, entrainment, and substrate mapping, as well as to perform radiofrequency ablation. Image merging was performed with multidetector CT in part of patients. After ablation, following up were conducted regularly by regional doctors. Result A total of 22 patients undergone ablation procedure, the ventricular tachyarrhythmia was successfully abolished in all patients. In Carto3 group,the distribution of successful ab- lation sites were as follow： septal wall of right ventricular outflow tract in 5 patients, free wall of right ventricular outtlow tract in 2 patients, aortomitral continuity in one case, tricuspid annulus in one case, left posterior fascicular in one case, both free wall of right ventricular outflow tract and left aorta sinus in one case. In CartoXP group, successful ablation sites were all in right ventricular outflow tract. The mean procedure time （57±29 min vs 62±10 min,P〈0.01 ） and the mean fluorosco- py time （5.23±5.42 min vs 8.45±2.33 rain, P〈0.01 ）were significantly shorter in Carto3 group compared with CartoXP group. During follow-up of 1 to 6 months, ventricular tachyarrhythmia recurred in none of the patients. Conclusions Three-dimensional mapping and ablation of ventricular tachyarrhythmia can be performed safely, effectively and quickly by using Car to 3 System.

关 键 词：电生理学 室性心律失常 CARTO 3三维标测 导管消融 射频电流 

分 类 号：R331.38[医药卫生—人体生理学] R541.7[医药卫生—基础医学]