三维标测系统在右室流出道室性早搏射频消融中的应用  

3D electroanatomical navigation system-guided catheter ablation for idiopathic right ventricular outflow tract premature ventricular contractions

作　　者：崔海明[1] 张家友[1] 廖德宁[1] 

机构地区：[1]第二军医大学长征医院心血管内科,上海200003

出　　处：《第二军医大学学报》2014年第8期910-914,共5页Academic Journal of Second Military Medical University

摘　　要：目的探讨使用三维电解剖指导右室流出道室性早搏(室早)射频消融方法的可行性及效果。方法选择连续入院行射频消融的频发室早患者共49例,分为两组,一组使用CARTO3三维电解剖系统指导消融(三维组,n=29),一组使用常规X线指导消融(常规组,n=20)。比较两组手术时间、X线透视时间、X线用量、手术费用、并发症、成功率和复发率等差异。结果三维组即刻成功率为100%(29/29),常规组为95%(19/20);常规组有3例并发症,三维组无明显并发症;随访6个月,常规组复发3例(15.0%),三维标测组无复发。三维组X线透视时间少于常规组[(1.3±3.6)min vs(44.2±28.2)min,P<0.01],相应的X线用量也大为减少[(93±242)mGy vs(3 919±2 309)mGy,P<0.01],但手术费用较高(P<0.01)。两组手术总时间差异无统计学意义。三维组29例患者中,有20例(69.0%)完全无X线透视。结论三维电解剖指导右室流出道室早射频消融是安全和有效的,可以显著减少X线透视时间和X线曝光量,部分可实现完全无X线透视完成消融手术。Objective To explore the feasibility and effectiveness of 3D electroanatomical navigation system（CARTO3） guided catheter ablation for idiopathic right ventricular outflow tract premature ventricular contractions （RVOT-PVCs）. Methods A total of 49 consecutive patients with RVOT-PVCs undergoing catheter ablation were divided into two groups： 3D group received CARTO3-guided ablation （n = 29） and the conventional group received X-Ray-guided ablation （n = 20）. The operation time, X-ray fluoroscopy time, X-ray fluoroscopy exposure, cost, complication, successfully rates and recurrence rates were compared between the two groups. Results The immediate success rates were 100% （29/29） in the 3D group and 95% （19/20） in the conventional group. Complications were found in 3 cases in the conventional group and not found in the 3D group. Fluoroscopy time of 3D group was significantly shorter than that of the X-Ray group（[1.3±3.6] min vs [44.2±28.2] min, P〈0.01）, and the radiation dose was also significantly lower than that of the X-Ray group （ [93±242] mGy vs [3 919± 2 3091 mGy, P〈0.01）, but the 3D group had significantly higher cost compared with the X-Ray group （P〈0.01）. There was no significant difference in the total operation time lengths between the two groups. Twenty（69.0%） of the 29 cases in the 3D group avoided fluoroscopy entirely. Conclusion Our study indicates that CARTO 3 system is safe and effective in guiding ablation for patients with RVOT-PVCs; the method can greatly reduce fluoroscopy time and fluoroscopy dose, and in many cases non-fluorosconic radiofrequencv catheter ablation（RFCA ）can be achieved.

关 键 词：右室流出道 室性早搏复合征 导管消融术 电解剖标测 X线 

分 类 号：R541.7[医药卫生—心血管疾病]