使用海星状电极快速解剖建模联合压力导管在心房颤动肺静脉隔离术中的优势  

The value of high-density mapping and fast anatomical mapping combined with pressure-monitoring catheter in pulmo-nary vein isolation

作　　者：李剑[1] 熊楠青[1] 李慧洋[1] 温志超[1] 朱首国 梁伟国[1] 施海明[1] 罗心平[1] 

机构地区：[1]复旦大学华山医院心内科,上海200040

出　　处：《中国心脏起搏与心电生理杂志》2017年第4期298-302,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：上海市卫计委基金(基金号:201540094);复旦大学附属华山医院院级基金(基金号:2016-916)

摘　　要：目的探讨海星状电极(Pentaray)导管对左房进行高密度标测快速解剖建模(FAM),联合使用压力导管在心房颤动(简称房颤)肺静脉电隔离术中的优势。方法序贯入组2015年7月1日到2016年5月30日在华山医院心内科确诊房颤、拟行环肺静脉电隔离术的患者,在Carto3系统下用环状电极(Lasso)或者Pentaray,以FAM法建立左房三维模型,根据使用的建模导管将患者分为Lasso组(L组)和Pentaray组(P组),两组患者均使用SmarttouchTM压力监测导管进行环肺静脉消融,术后在窦性心律下通过肺静脉与左房的双向起搏,以传导阻滞为手术终点。记录患者的一般情况,手术时间以及消融点的平均压力等参数,术后3个月、6个月随访24h动态心电图,并记录患者用药情况,分析消融效果。结果共纳入符合要求的患者52例,其中L组30例,P组22例。所有患者中,阵发性房颤43例,男性占73%。手术均能达到肺静脉电隔离的终点。两组建模时间为:L组(18.3±2.43)min,P组(13.3±3.63)min(P<0.001);L组和P组总消融时间分别为:(157.1±13.55)min和(138.9±11.30)min(P<0.001),两组患者肺静脉隔离使用时间分别为L组(98.6±12.26)min和P组(95.9±11.56)min,(P=0.427)。术后6个月房颤复发率L组为22.7%,P组为23.3%(P=0.752)。结论使用Pentaray进行心房高密度标测快速建模联合压力导管,可以在保证安全性的前提下,缩短房颤肺静脉电隔离的时间,提高手术成功率。Objective To explore the value of the starfish shaped electrode （Pentaray） high density mapping the left atrium using fast anatomical mapping（FAM）, and to evaluate the advantages of Pentaray plus FAM combined Smarttouch catheter in pulmonary vein isolation（PVI） in atrial fibrillation（AF）. Methods We sequentially en- rolled AF patients diagnosed by the Department of Cardiology of Huashan Hospital from July 1, 2015 to May 30, 2016. All patients were candidates of PVI using Carto3 system with circle electrode （Lasso） or Pentaray, with FAM method to establish the 3D model of the left atrium. According to the different catheter, the patients were divided into Lasso group （L group） and Pentaray group （P group）. We applied pressure monitoring catheter （Smarttouch） in pulmonary vein ablation. The endpoint was the pulmonary vein and left atrial due-direction block. The baseline, operation time and the mean pressure of ablation point were recorded. The patients were followed up for Holter in 3 months and 6 months. Results Fifty two patients who meet the criteria（L group 30, P group 22） were enrolled. All patients reached the end point PVI. The time of left atrium mapping was： L group （18.3±2.43）min, （13.3±3. 63）rain P group （P〈0.001） ; the procedure time in L and P group were （157.1±13.55）min and （138.9±11.30）min（P〈0.001）, respectively. The time to PVI in group L and group P were （98.6±12.26）min and （95.9±11. 56）min （P=0.427）, respectively. At the 6 months, AF recurrence rate was 22.7% in L group, 23.3% in P group（ P = 0. 752 ）. Conclusion Atrial high density mapping using starfish shaped electrode catheter combinedwith pressure monitoring catheter provide a premise of safety, can shorten the atrial PVI, improve the success rate of surgery.

关 键 词：心房颤动 肺静脉电隔离 高密度标测 海星状电极 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]