三维引导下多极高密度标测在右室流出道室性早搏消融中的应用  

The value of multielectrode contact mapping for 3D mapping and ablation of right ventricular outflow tract arrhythmia

作　　者：陶四明[1] 韩明华[1] 张新金[1] 郑甲林[1] 魏巍[1] 杨志刚[1] 

机构地区：[1]云南省第二人民医院心脏内科,云南昆明650021

出　　处：《中国心脏起搏与心电生理杂志》2016年第1期41-45,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的评价多极接触标测在指导三维电解剖引导下右室流出道(RVOT)室性早搏(简称室早)消融的疗效。方法选择32例RVOT室早患者,据术中室早发作的频度分为两组:室早<1次/分者采用多极导管高密度标测(多极组);室早≥1次/分者采用单导管逐点标测(单极组);确定激动起源靶点后再进行起搏标测证实并实施消融治疗。比较两组的标测时间、消融次数及时间、X线曝光时间、消融成功率。结果 29例患者完成电生理标测及消融,单极组16例,多极组13例。多极组平均采集有效标测点明显多于单极组;激动顺序标测耗时两组未见差异。多极组总手术时间明显长于单极组,但是在平均消融次数、消融时间、X线透视时间等指标比较,多极组却显著少于单极组,所有患者均达到即刻消融终点。随访(6.9±3.2)个月,单极组1例复发。结论采用多极标测导管对RVOT局部进行高密度电解剖标测快捷、精确,提高消融成功率,尤其是对术中室早发作较少的患者。Objective To evaluate the value of multieleetrode contact mapping in ablation for right ventricular outflow tract ventricular arrhythmia with three dimensions mapping system. Methods We enrolled thirty-two patients with right ventricular outflow tract ventricular premature beat（VPB）. According to the frequencies of VPB, the patients were divided into two groups., multielectrode high density mapping group and single catheter point by point mapping group. Pacing mapping must be applied in confirming the results of activation mapping before ablation. Compared of the times or time of radiofrequency（RF）, time of X ray expose and success rate of ablation. Results Twenty-nine patients completed the process of mapping and ablation, including multielectrode high density mapping group（13 case） and single catheter point by point mapping group（16 case）. The mean number of effect mapping points and the overall operation time in group of multielectrode contact mapping were more than that of point by point mapping group, and there were significantly difference between two groups. But the mean number of RF lesions, RF time and fluoroscopy time in multielectrode contact mapping group were less than those of group of single catheter, meanwhile, there were significantly different between two groups. The mean time of followed-up was （6.9 ± 3. 2） months, only one patient reccurred the VPB in single catheter mapping group. Conclusion There are some important values in multielectrode contact high density mapping for RVOT arrhythmia, especially for the patients with low frequency of VPB or the ventrcular premature beat orgin from superior pulmonary valve.

关 键 词：心血管病学 右室流出道 室性早搏 导管消融 射频电流 接触标测 多极高密度标测 

分 类 号：R541.7[医药卫生—心血管疾病] R454.1[医药卫生—内科学]