Carto3在指导阵发性室上性心动过速射频消融术中的应用  

Application of Carto3 in guiding radiofrequency catheter ablation for paroxysmal supraventricular tachycardia

作　　者：齐书英 李洁[1] 刘文秀 马彦卓 郭晓萍 汝磊生 王冬梅[1] Qi Shuying;Li Jie;Liu Wenxiu;Ma Yanzhuo;Guo Xiaoping;Ru Leisheng;Wang Dongmei(Department of Cardiovascular Medicine,980th Hospital,Chinese PLA Joint Support Force,Shijiazhuang 050082,China)

机构地区：[1]中国人民解放军联勤保障部队第980医院心血管内科,石家庄050082

出　　处：《中国循证心血管医学杂志》2020年第2期207-209,213,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：中国人民解放军联勤保障部队第980医院院课题(2009001)。

摘　　要：目的总结阵发性室上性心动过速(PSVT)射频消融治疗病例,比较应用三维电解剖标测系统Carto3指导PSVT导管消融的疗效及安全性,着重分析永久性Ⅱ°以上房室传导阻滞(AVB)的发生率。方法自1992年1月1日至2017年12月31日间,联勤保障部队第980医院心血管内科共完成PSVT导管消融治疗且资料齐全的病例2098例。使用Carto3前称为二维组,使用Carto3后称为三维组,比较使用Carto3指导PSVT导管消融的疗效及安全性,着重分析永久性Ⅱ°以上AVB的发生率,总结发生AVB的病例特点,分析相关因素。结果共完成PSVT导管消融治疗病例2098例,其中发生永久性Ⅱ°以上AVB 5例,发生率0.24%。二维组1443例,发生永久性Ⅱ°以上AVB 5例,发生率0.35%;三维组655例,未发生永久性Ⅱ°以上AVB。发生AVB的病例中,房室结折返性心动过速2例,后间隔部旁道2例,希氏束旁旁道1例。发生AVB时消融术者手术年限情况:二维时代术者2名,发生并发症时术龄分别是7年和15年,三维时代术者2名,发生并发症时术龄分别是1年和3年。结论间隔部旁道消融和房室结慢径改良有发生AVB的风险,应用三维标测系统指导阵发性室上速消融治疗可显著降低永久性房室传导阻滞的发生风险。Objective To sum up the cases of paroxysmal supraventricular tachycardia(PSVT)treated with radiofrequency catheter ablation(RFCA),compare the curative effect and safety of RFCA guided by Carto3,and analyze mainly the incidence rate of permanent atrioventricular block(AVB)overⅡ°.Methods PSVT cases(n=2098)with complete materials were treated with RFCA in the 980th Hospital of Chinese PLA Joint Support Force from Jan.1,1992 to Dec.31,2017.All cases were divided into 2-dimensional group(2-D group,before Carto3 application)and 3-dimensional group(3-D group,after Carto3 application).The curative effect and safety of RFCA guided by Carto3 were compared.The incidence rate of permanent AVB overⅡ°was analyzed mainly,characteristics of AVB were summed up,and relevant factors were analyzed.Results There were totally 2098 cases of PSVT treated with RFCA,and among them 5 cases suffered from permanent AVB overⅡ°and incidence rate was 0.24%.There were 1443 cases in 2-D group and 5 cases suffered from permanent AVB overⅡ°and incidence rate was 0.35%.There were 655 cases in 3-D group and there were no cases of permanent AVB overⅡ°.In AVB cases,there were 2 cases of atrioventricular nodal reentrant tachycardia(AVNRT),2 cases of postseptal accessory pathway and 1 case of para-His-bundle accessory pathway.In 2-D group,there were 2 cases with AVB after respectively 7 y and 15 y,and in 3-D group,there were 2 cases with AVB after 1 y and 3 y.Conclusion There is risk of permanent AVB during RFCA treatments of septal accessory pathway and AVNRT,and this risk can be significantly reduced by RFCA for treating PSVT guided by Carto3.

关 键 词：三维电解剖标测系统 阵发性室上性心动过速 导管消融 房室传导阻滞 

分 类 号：R541.71[医药卫生—心血管疾病]