心外膜CARTO标测指导下双极射频消融治疗室壁瘤相关室性心律失常  

Bipolar radiofrequency ablation guided by three-dimensional electroanatomical mapping（CARTO） system for control of ventricular arrhythmias in patients with left ventricular aneurysm

作　　者：刘长城[1] 苏兆萍 王粮山 李波[1] 于洋[1] 李琴[1] 李海涛[1] 胡晖[1] 吴震[1] 方颖[1] 韦华[1] 顾承雄[1] 

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管病研究所心外科,100029 [2]潍坊医学院公共卫生与管理学院流行病与卫生统计学教研室,261053

出　　处：《中华胸心血管外科杂志》2016年第5期261-264,268,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金（81370436）,北京市科委项目（Z131107002213003）,北京市教委项目（KZ201410025028）

摘　　要：目的评估利用三维电解剖标测系统（CARTO）在心外膜标测指导下，施行双极射频消融治疗室壁瘤相关室性心律失常的安全性、可行性和临床效果。方法2009年9月至2014年12月33例患者心肌梗死后并发室壁瘤，且术前24h动态心电图显示室性心律失常超过3000次。按照患者家属是否同意双极射频消融治疗，分为两组：射频组15例，行不停跳冠状动脉旁路移植术（OPCABG）＋室壁瘤成形术联合双极射频消融术；非射频组18例，行OPCABG＋室壁瘤成形术。术后复查24h动态心电图和超声心动图并随访，比较两组心功能和室性心律失常的改善情况。结果两组均无手术死亡，非射频组围手术期脑梗塞1例，其余均治愈出院。术后及随访期间两组患者左心室射血分数较术前明显改善（P〈0．05），左心室舒张末期内径较术前显著缩小（P〈0．05）；但组间比较差异无统计学意义。出院时两组患者均复查24h动态心电图，射频组的室性心律失常发生较术前显著减少（P〈0．05）。术后组间比较，射频组24h室性心律失常频次明显减少（P〈0．05）。结论心外膜CARTO标测指导下双极射频消融是一种治疗室壁瘤相关室性心律失常的安全、可行的外科方法，近期临床疗效尚可，远期疗效仍需进一步随访。Objective To evaluate the feasibility and efficacy of bipolar radiofrequency ablation to treat left ventricular aneurysm related ventricular arrhythmias guided by CARTO mapping system. Methods Thirty-three patients with ventricular aneurysm related-ventricular arrhythmias proved by Halter（ the frequencies of ventricular arrhythmia more than 3 000 per day） were divided into two groups namely bipolar radiofrequency ablation group （n = 15 ） and non-bipolar radiofrequency ablation group（ n = 18 ）. All patients accepted off-pump coronary artery bypass grafting（OPCABG） and left ventricular aneurysm repair （LVAR）. Comparison of improvement of ventricular arrhythmias and heart function accepted two intervening management dur- ing periods of preoperation, discharge and follow up. Results There was no operation related-death in both groups. One patient in non-bipolar radiofrequency ablation group suffered from peri-operative cerebral infarction. All patients were re-checked with Hoher before discharge and the frequencies of ventricular arrhythmia were significantly decreased comparing to preoperation at bipolar radiofrequency ablation group （ P 〈 0.05 ）, and ventricular arrhythmias were more effectively inhibited in bipolar ra- diofrequency ablation group than non-bipolar radiofrequency ablation group（ P 〈 0.05 ）. During discharge and follow up, heart function of two groups was improved remarkably confirmed by echocardiographm（ECG）. Conclusion Bipolar radiofrequency ablation guided by CARTO mapping system to treatment of ventricular aneurysm related-ventricular arrhythmias is a feasible and effective surgical tactic, but long-term efficacy of this surgical procedure should be further observed.

关 键 词：电解剖标测系统 导管消融术 室性心律失常 心脏室壁瘤 冠状动脉旁路移植术 非体外循环 

分 类 号：R541.7[医药卫生—心血管疾病]