无射线全三维技术指导下射频消融治疗妊娠期心律失常的研究  

Study of fluoroscopy-free three-dimensional radiofrequency technique in the treatment of arrhythmia during pregnancy

作　　者：喻荣辉[1] 路军 许丰强[2] 赵育洁 王睿[4] 徐冬玲[5] 王海雄 张志军 赵欣[1] 李松南[1] 刘念[1] 白融[1] 马长生[1] Yu Ronghui;Lu Jun;Xu Fengqiang;Zhao Yujie;Wang Rui;Xu Dongling;Wang Haixiong;Zhang Zhijun;Zhao Xin;Li Songnan;Liu Nian;Bai Rong;Ma Changsheng(Department of Cardiology,Beijing Anzhen Hopital,Capital Medical University,Beijing 100029,China;Department of Cardiology,the Affiliated Hospital of Qingdao University,Qingdao 266003,China;Department of Cardiology,Zhengzhou Cardiovascular Hospital,Zhengzhou 450016,China;Department of Cardiology,First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Cardiology,the Second Hospital of Shandong University,Jinan 250033,China;Department of Cardiology,Shanxi Cardiovascular Hospital,Taiyuan 030024,China;Department of Cardiology,Shanxi Academy of Medical Sciences,Shanxi Bethune Hospital,Taiyuan 030032,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029 [2]青岛大学附属医院心内科,266003 [3]郑州市心血管病医院心内科,450016 [4]山西医科大学第一医院心内科,太原030001 [5]山东大学第二医院心内科,济南250033 [6]山西省心血管病医院心内科,太原030024 [7]山西白求恩医院心内科山西医学科学院,太原030032

出　　处：《中国医药》2020年第7期1012-1016,共5页China Medicine

基　　金：国家重点研发计划(2018YFC1312500);北京市科技计划(Z181100001718174)。

摘　　要：目的探讨无射线全三维技术指导下射频消融治疗妊娠期心律失常的有效性与安全性。方法选择2015年1月至2019年8月多中心收治的44例耐药性心律失常的妊娠期患者作为研究对象,在三维电解剖标测系统指导下,建立规范化无射线全三维技术流程。手术中,使用压力导管或多极导管进行三维重建,放置标测电极,标准电生理标测后用压力导管进行消融。结果 44例患者中阵发性室上性心动过速19例,房性心律失常15例,室性心律失常10例。所有患者均成功无射线建模并在无射线下消融成功,射血分数为(52±8)%,三维重建时间(18±4) min,消融时间(201±86) s,手术时间(70±12) min。无围术期不良事件发生。所有患者成功分娩,随访6个月均未复发。结论合并耐药性心律失常的孕妇心功能偏低,无射线全三维技术指导下射频消融治疗妊娠期耐药性心律失常安全有效。Objective To explore the effectiveness and safety of fluoroscopy-free three-dimensional radio-frequency ablation of arrhythmia during pregnancy.Methods From January 2015 to August 2019,44 pregnant women with drug-resistant arrhythmia admitted to Beijing Anzhen Hospital,Capital Medical University were selected.Under the guidance of CARTO3 three-dimensional electroanatomic mapping system,the standardized three-dimensional(T3D)technology workflow was established.During the operation,pressure sensing catheter or multipolar catheter was used for three-dimensional reconstruction,and then the mapping electrode was placed.After the standard electrophysiological mapping,the pressure sensing catheter was used for ablation.Results Among the 44 patients,19 cases were paroxysmal supraventricular tachycardia,15 cases were atrial arrhythmia and 10 cases were ventricular arrhythmia.All patients were successfully modelled without radiation and ablated without radiation.The ejection fraction was(52±8)%,the three-dimensional reconstruction time was(18±4)min,the ablation time was(201±86)s,and the operation time was(70±12)min.No perioperative adverse events occurred.All the patients were delivered successfully,and no recurrence was found after 6 months follow-up.Conclusions The cardiac function of pregnant women with drug-resistant arrhythmia is low.The fluoroscopy-free three-dimensional radiofrequency ablation technology is safe and effective in the treatment of drug-resistant arrhythmia in pregnancy.

关 键 词：耐药性心律失常 妊娠期 无射线 全三维 

分 类 号：R714.252[医药卫生—妇产科学]