Paso起搏标测在右心室流出道室性早搏消融中的运用价值  

作　　者：孟坚强 王超权 任品芳 朱德文 张志诚 

机构地区：[1]浙江省绍兴市中心医院,312030

出　　处：《浙江临床医学》2020年第8期1147-1149,共3页Zhejiang Clinical Medical Journal

摘　　要：目的 探讨在CARTO3三维标测指导下运用PASO起搏标测软件标测右心室流出道室性早搏(简称右流室早)消融靶点的可行性及精确性.方法 分析2018年6月至2019年5月行射频消融治疗的50例右流室早,选取以激动标测+PASO起搏标测右流室早25例为观察组,采用激动标测+人工起搏标测右流室早25例为对照组.两组患者均先行激动标测,寻找到室性早搏(简称室早)的最早激动点,然后观察组通过CARTO3系统PASO起搏标测自动比较体表室早,室早相似度>0.94视为有效消融靶点进行消融,而对照组将心室起搏标测所获得的QRS波与自发室早体表心电图≥11个导联QRS波的振幅/时限/形态完全一致认为是有效消融靶点进行消融,分别记录两组的标测时间、PASO相似度、即刻手术成功率、术后1个月手术成功率及手术相关并发症情况.结果 观察组有效靶点相似度均≥0.95,平均相似度为0.97,对照组成功消融靶点均为起搏标测时QRS波的振幅/时限/形态与体表心电图11个导联完全一致;两组的即刻手术成功率及术后1个月随访手术成功一致,且均未发生血管并发症、血栓栓塞、心脏穿孔或心包填塞等并发症.结论 CARTO3三维标测指导下应用PASO起搏标测软件能帮助术者快速、客观、精确、量化地找到最佳成功消融靶点,并且不增加手术相关并发症.Objective To explore the feasibility and accuracy of the application of PASO pacing mapping to map the ventricular premature beat ablation target in the right ventricular outflow tract under the guidance of CARTO3 three-dimensional electrical dissection measurement.Methods 50 ventricular premature beat cases which underwent radiofrequency ablation treatment had been analyzed at cardiovascular department in Shaoxing Central Hospital from June 2018 to May 2019,which been divided into two groups,PASO group(n=25)(experimental group)which selected by adopting activation mapping and PASO pacing mapping control group(n=25)which adopted activation mapping and artificial pacing mapping.The earliest excitation point of premature ventricular contractions(VPBs)was found by the first excitation mapping in both groups.Then,the observation group was automatically compared with the body surface ventricular premature beat by carto3 system Paso pacing mapping,and the ventricular premature similarity>0.94 was regarded as the effective ablation target for ablation.In the control group,the amplitude/time limit/shape of QRS wave obtained by ventricular pacing mapping was consistent with that of QRS wave in more than 11 leads of spontaneous ventricular early body surface electrocardiogram,which was considered as an effective ablation target.The mapping time,Paso similarity,immediate operation success rate,1 month operation success rate and operation related complications of the two groups were recorded.Results The experimental group got the effective target similarity of 0.95 or even higher,and the average similarity was 0.97.The successfill ablation targets in control group were completely in accord with body surface electrocardiogram of 11 or higher leads of QRS wave amplitude or time limit,or morphology.No significant difference was found between the immediate success rate and postoperative success rates which followed up for 1 month.No complications like thromboembolism,vascular complications,cardiac wall perforation or cardiac tam

关 键 词：室性早搏 右心室流出道 PASO起搏标测 室早相似度 

分 类 号：R54[医药卫生—心血管疾病]