三维标测指导下儿童右心室室性快速性心律失常射频导管消融  

Catheter ablation of right ventricular tachyarrhythmia in children guided by 3-dimensional electroanatomic mapping systems

作　　者：高路[1] 林利[1] 崔烺[1] 于霞[1] 袁越[1] Gao Lu;Lin Li;Cui Lang;Yu Xia;Yuan Yue(Beijing Children＇s Hospital,Capital Medical University,National Center for Children＇s Health,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院心内科,100045

出　　处：《中华心律失常学杂志》2018年第5期397-401,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的近年来三维标测指导下儿童经导管射频消融广泛应用于儿童室性快速性心律失常，本文旨在探讨Ensite Velocity三维标测（美国雅培公司）指导下射频消融对于儿童右心室室性快速性心律失常的X线曝光的影响。方法回顾性分析2003年3月至2017年12月首都医科大学附属北京儿童医院心内科行射频消融治疗右心室室性快速性心律失常的患儿230例，分为常规组111例（男61例，女50例），年龄（8.6±3.5）岁，Ensite NavX组47例（男27例，女20例），年龄（8.8±3.2）岁与Ensite Velocity组72例（男39例，女33例），年龄（8.2±3.4）岁。结果常规组、Ensite NavX组与Ensite Velocity组的手术成功率分别为100%、100%和98.6%，差异无统计学意义。常规组、Ensite NavX组与Ensite Velocity组的手术时间分别为（175.2±36.7）min、（151.3±46.4）min和（107.7±22.1）min，Ensite Velocity组与常规组和Ensite NavX组相比手术时间缩短（均P〈0.05），Ensite NavX组与常规组的手术时间差异无统计学意义。Ensite NavX组与Ensite Velocity组的累积X线曝光量分别为4.0 mGy（中位数）和0 mGy（中位数），剂量面积乘积分别为43.0 μGy/m^2（中位数）和0 μGy/m^2（中位数），与常规组63.5 mGy/m^2（中位数）和526.0 μGy/m^2（中位数）相比较均显著降低，而Ensite Velocity组的累积X线曝光量和剂量面积乘积较Ensite NavX组也显著降低（均P〈0.001）。结论应用Ensite Velocity三维标测系统指导儿童右心室室性快速性心律失常的射频消融可以明显减少X线曝光量，明显缩短手术时间。ObjectiveRadiation exposure related to conventional fluoroscopic guidance carries stochastic and deterministic effects on both patients and medical staff, which are potentially more harmful in children. The aim of our study was to investigate the efficacy, safety and feasibility of Ensite Velocity system in the catheter ablation of right ventricular tachyarrhythmia in children.MethodsTwo hundred and thirty pediatric patients with right ventricular tachyarrhythmia underwent catheter ablation from March 1st, 2003 to December 31th, 2017 were analyzed retrospectively. The first 111 patients （conventional group） were treated under fluoroscopic guidance, the following 47 patients （Ensite NavX group） were treated using Ensite NavX system, and the latest 72 patients （Ensite Velocity group） were treated using Ensite Velocity system.ResultsThe acute success rates of the conventional, Ensite NavX, and Ensite Velocity groups were 100%, 100%, 98.6% respectively, withno statistically significant difference （P〉0.05） . The patients in Ensite Velocity group completed the ablation within （107.7±22.1） min, which was statistically reduced compared with conventional group （175.2±36.7） min and Ensite NavX group （151.3±46.4） min （P〈0.05 for both） , whereas there was no significant decrease in Ensite NavX group compared with conventional group. The accumulated entrance dose was significantly decreased in Ensite Velocity group （median 0 mGy） and Ensite NavX group （median 4.0 mGy） compared with conventional group （median 63.5 mGy; P〈0.001） . Dose area product was significantly decreased in Ensite Velocity group （median 0 μGy/m^2） and Ensite NavX group （median 43.0 μGy/m^2） compared with conventional group （median 526.0 μGy/m^2; P〈0.001） . Moreover, the accumulated entrance dose and dose area product in Ensite Velocity group were significantly lower than that in Ensite NavX group （P〈0.001） .ConclusionOur study indicated that the use of Ensite Velocity 3D mapping sy

关 键 词：导管消融术 三维标测 儿童 室性心律失常 

分 类 号：R725.4[医药卫生—儿科]