PaSO起搏标测软件在右心室流出道室性期前收缩射频消融中的应用  

Utility of PaSO software in catheter ablation of premature ventricular contraction originating from right ventricular outflow tract

作　　者：陈太波[1] 高鹏[1] 程中伟[1] 邓华[1] 程康安[1] 方全[1] CHEN Tai-bo;GAO Peng;CHENG Zhong-wei;DENG Hua;CHENGKang-an;FANG Quan(Department of Cardiology,Peking Union Medical College Hospital,Chinese Academyof Medical Science and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院心内科,北京100730

出　　处：《中国介入心脏病学杂志》2019年第5期283-287,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨PaSO起搏标测软件(CARTO3,美国强生公司)在右心室流出道(RVOT)室性期前收缩(PVC)射频消融治疗中的应用价值。方法回顾性分析2016年1月至2016年8月于北京协和医院接受射频消融治疗的RVOT PVC患者共21例,入选患者同时行激动标测和PaSO起搏标测。将激动标测最早点定义为A点,PaSO起搏标测相似度软件评分最优点定义为B点,消融有效点定义为C点。比较两种标测方法指导RVOT PVC射频消融治疗的准确度。结果患者术中激动标测取点数为(11.0±5.0)个,激动顺序标测显示最早激动部位电位提前体表QRS时限15～36 ms(27.3±5.6)ms。PaSO起搏标测取点数为(10.0±5.0)个,起搏标测最优点与自发PVC QRS相似度为94.3%～99.2%[(97.4±1.5)%]。激动标测和PaSO起搏标测在判断PVC内膜靶点上比较,差异无统计学意义[AC间距(5.9±3.1)mm比BC间距(5.1±2.7)mm,P=0.320]。激动标测最早点与PaSO起搏标测最优点之间的中位距离为7.7(2.6,16.7)mm。结论 PaSO自动匹配起搏标测软件指导RVOT PVC射频消融靶点的准确度不劣于激动标测。基于自动匹配运算的PaSO起搏标测软件不受术中PVC负荷的限制,可以客观、准确、快速地定位PVC起源点,从而实现PVC精准消融。Objective To assess the utility of a quantitative approach to paced QRS to premature ventricular contraction (PVC) morphology matching using PaSO software (CARTO3, Biosense Webster), to localize the PVC site of right ventricular outfl ow tract (RVOT) origin. Methods 21 patients with PVC originating from RVOT underwent catheter ablation between January 2016 and August 2016 were enrolled in this study. All the patients received both activation mapping and PaSO pace mapping during the procedure. The earliest local activation time points were defined as point A, the highest percent of PaSO score points were defi ned as point B, and the eff ective ablation target points defi ned as point C. Results For activation mapping, the average number of activation mapped sites was (11.0±5.0) per patient, and the value of earliest activation points varied between 15-36 ms [(27.3±5.6) ms];For PaSO pace mapping, the number of pace-mapped sites averaged (10.0±5.0) per patient, and the highest percent PaSO score (pace mapping) for the targeted PVC varied between 94.3% and 99.2%[(97.4±1.5)%]. The distance of AC and BC was comparable [(5.9±3.1) mm vs.(5.1±2.7) mm, P=0.320]. And the median distance between A and B was 7.7 (2.6,16.7) mm. Conclusions The accuracy of pace mapping facilitated by the PaSO software in guiding the ablation target site of PVC from RVOT is comparable to that of activation mapping.

关 键 词：起搏标测 室性期前收缩 右心室流出道 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]