非接触球囊导管标测系统指导心房扑动消融的初步经验  

Initial experience in mapping and ablation of atrial flutter using a noncontact mapping system

作　　者：邹建刚[1] 曹克将[1] 陈明龙[1] 杨兵[1] 陈椿[1] 单其俊[1] 李文奇[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,210029

出　　处：《中华心血管病杂志》2002年第10期579-582,共4页Chinese Journal of Cardiology

摘　　要：目的　评价非接触球囊导管标测系统在心房扑动 (房扑 )标测和射频消融中的临床应用。方法　 7例房扑患者 ,年龄 (6 0± 10 )岁 ,男 4例 ,女 3例。其中 1例为房间隔缺损修补术后 ,2例为采用常规方法消融典型房扑后复发患者。应用非接触球囊导管标测系统构建右房三维几何模型 ,标测心动过速的折返激动顺序和关键峡部 ,并利用其导航系统指导峡部的线性消融。消融后分别于峡部两侧起搏判断峡部阻滞情况。结果　 6例患者诱发出房扑 ,心动过速周长 (2 16± 2 2 )ms。6例房扑均为峡部依赖型 ,2例呈逆钟向传导 ,4例呈顺钟向传导 ;4例房扑呈双环折返激动 ;7例消融均成功 ,房扑不再诱发 ,峡部呈完全双向传导阻滞 ;手术时间 (30 0± 12 9)min ,X线曝光时间 (2 5 0± 6 5 )min ,放电次数 (2 5 7± 12 1)次。无手术并发症。随访 3～ 14个月无复发病例。结论　在房扑标测和消融中应用非接触球囊导管标测系统是安全有效的 ,不仅能确定折返环路 (特别是双环折返激动 )的顺序和关键峡部 ,而且能准确判断线性损伤的连续性 ,同时可减少X线曝光时间。Objective To evaluate the effects of a novel noncontact mapping system in guiding mapping and ablation of atrial flutter (AFL) Methods Four male and 3 female patients [mean age (60±10) years] with AFL were included in the study One patient had atrial septal defect after surgical operation. Two patients recurred after ablation of typical AFL using the conventional method Using the noncontact mapping system, three dimensional geometry of right atrium was constructed, the reentrant activation sequence was mapped, and the critical isthmus of AFL was identified Then, the radiofrequency ablation with linear lesion was performed at the critical isthmus guided by the locator system After ablation, pacing at two side of critical isthmus was made to assess the bi directional conduction block Results AFL was induced in 6 patients The cycle length was (216±22) ms In the 6 patients with isthmus dependent AFL, 2 were counter clockwise and 4 were clockwise Four patients were double loop AFL All 7 patients were noninducible and the complete bi directional conduction block developed The procedure time was (300±129) min, the X ray fluoroscopic exposure time was (25 0±6 5) min, (25 7±12 1) times of radiofrequency pulses were delivered No complication occurred No recurrence was observed during follow up of 3-14 months Conclusions The study demonstrates that the use of noncontact mapping system is safe and effective for mapping and ablation of AFL The system can correctly identify the reentrant activation sequence and the critical isthmus. In addition, it can precisely verify the continuity of the linear lesions as well as reduce the fluoroscopic exposure time length

关 键 词：非接触球囊导管标测系统 心房扑动 导管消融术 临床应用 

分 类 号：R541.75[医药卫生—心血管疾病]