EnSite Velocity指导下室上速、室性心律失常的绿色消融  

Zero-fluoroscopy ablation of supraventricular tachycardia and ventricular arrhythmia guided by EnSite Velocity system

作　　者：王月刚[1] 孙祝华[2] 黎健勇[1] 董剑廷[3] Wang Yue-gang;Sun Zhu-hua;Li Jian-yong;Dong Jian-ting(Department of Cardiology,Nanfang Hospital Affiliated to Southern Medical University,Guangzhou Guangdong 510515;Huiqiao Medicine Center,Nanfang Hospital Affiliated to Southern Medical University,Guangzhou Guangdong 510515;epartment of Cardiology,Zhongshan People s Hospital,Zhongshan Guangdong 528403,China)

机构地区：[1]南方医科大学南方医院心内科,广东广州510515 [2]南方医科大学南方医院惠侨科,广东广州510515 [3]中山市人民医院心内科,广东中山528403

出　　处：《实用心电学杂志》2018年第1期29-32,共4页Journal of Practical Electrocardiology

基　　金：国家自然科学基金青年项目(30800462);南方医科大学南方医院院长基金重点项目(2015A002)

摘　　要：零X线下进行电生理的各类射频消融手术被称作"绿色消融"。随着医疗器械设备的完善和术者临床操作水平的提高,它已成为治疗快速心律失常的重要方法。绿色消融具有无辐射、成功率高、并发症少等优点,能高效安全地完成电生理手术。Ensite Velocity三维电解剖系统具备较好的兼容性,任何导管只要与体内接触产生电阻后即可显示,可利用任何导管进行血管径路和心腔建模。2017年6至9月,南方医科大学南方医院在Ensite Velocity系统指导下尝试进行了22例零X线绿色消融,成功消融21例,1例左侧旁路因患者身材矮小致导管不能到位而失败,改为X线透射下成功消融。手术种类包括普通室上速、三尖瓣峡部依赖型房扑、右室流出道室早等。零X线下能完成绝大部分室上速和常规室早的消融,但也存在一些缺陷,如不能实时显示血管和心脏解剖结构、对术者操作手感要求较高、成本更高等。实施零X线手术时应当有床旁超声,以备安全;最好能在数字减影血管造影室进行手术,以便消融失败时能立即改为X线透射下消融。Zero-fluoroscope ablation is named“green ablation”.With the improvement of medical equipments and manipulation skills,it has become an important therapy for tachyarrhythmias.Green ablation has the advantages of being radiationless,high success rate and fewer complications,which enable electrophysiological surgery to be completed effectively and safely.EnSite Velocity three-dimensional electro-anatomical mapping system is remarkably compatible-any catheter can be showed through contacting the body and generating resistance;any catheter can be utilized in the modeling of vascular pathway and heart cavity.Nanfang Hospital Affiliated to Southern Medical University attempted to perform zero-fluoroscopy green ablation for 22 patients guided by EnSite Velocity system from June to September in 2017.Except for one failed case of left accessory pathway,21 cases succeed.The reason for failure was the patient was short and thus catheter could not be moved in place,and a second ablation was successful with the help of X-ray.Tachycardias in the procedure included common supraventricular tachycardia,tricuspid isthmus dependent atrial flutter,premature ventricular contraction(PVC)originating from right ventricular outflow,etc.Most supraventricular tachycardia and common PVC can be cured by zero-fluoroscopy ablation.However,there are also shortcomings in zero-fluoroscopy ablation,for example,non-real-time display of vascular and cardiac anatomical structure,high requirement of operation sense and more cost.During the process of zero-fluoroscopy surgery,bedside ultrasound should be prepared in case of emergency.It is advisable to perform the operation in digital subtraction angiography room so as to facilitate the switch to fluoroscope immediately in case of failure.

关 键 词：ENSITE Velocity三维电解剖系统 阵发性室上速 室性早搏 射频消融 绿色电生理 

分 类 号：R541.7[医药卫生—心血管疾病]