磁导航指导消融和抗心律失常药物治疗左心室起源频发室性期前收缩  

Comparison between the remote magnetic navigation-guided ablation and antiarrhythmic drugs in the treatment of frequent left ventricular premature contractions

作　　者：范吉利[1] 金奇[2] 李翔 尚文涛 张凝[2] 凌天佑[2] 陈康[2] 潘文麒[2] 吴立群[2] FAN Jili;JIN Qi;LI Xiang;SHANG Wentao;ZHANG Ning;LING Tianyou;CHEN Kang;PAN Wenqi;WU Liqun(Department of Cardiology,Taihe County People’s Hospital,Fuyang 236000,China;Department of Cardiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]安徽太和县人民医院心内科,安徽阜阳236000 [2]上海交通大学医学院附属瑞金医院心脏内科,上海200025

出　　处：《内科理论与实践》2020年第6期375-380,共6页Journal of Internal Medicine Concepts & Practice

基　　金：促进市级医院临床技能与临床创新三年行动计划项目(项目编号:SHD2020CR4096)。

摘　　要：目的:比较机器人磁导航(remote magnetic navigation, RMN)指导消融治疗与抗心律失常药物治疗左心室不同部位起源频发室性期前收缩(premature ventricular contraction, PVC)的有效性和安全性。方法:共纳入60例左心室起源的PVC患者,根据患者年龄和性别1∶1配对,RMN消融治疗组(RMN组)和抗心律失常药物治疗组(药物组)各30例;其中,各组左心室流出道(left ventricular outflow tract,LVOT)来源PVC和非LVOT来源PVC各15例。RMN组采用RMN联合Carto三维标测系统行导管消融治疗;药物组为至少使用1种Ⅰ~Ⅳ类抗心律失常药物。研究有效性终点为治疗后24 h动态心电图(Holter) PVC<4 000次/24 h;安全性终点为手术相关并发症和药物相关不良反应发生率。结果:RMN组手术急性成功率为90%,其中,LVOT和非LVOT PVC消融成功率差异无统计学意义(87%比93%,P=1.00)。RMN组有效率显著高于药物组(90%比47%,P<0.001)。RMN组无手术相关并发症,药物组有2例出现药物相关不良反应,安全性终点差异无统计学意义(0比7%,P=0.15)。亚组分析显示,无论是起源于LVOT还是非LVOT来源PVC,RMN组的有效率均高于药物组(P<0.05)。结论:与传统抗心律失常药物相比,RMN指导消融治疗左心室不同部位起源频发PVC更为有效,并且同样安全。Objectives To compare the efficacy and safety of remote magnetic navigation(RMN)-guided catheter ablation to antiarrhythmic drugs(AAD) in the treatment of frequent premature ventricular contractions(PVC) originating from the different sites of left ventricles(LV). Methods Total 60 cases with PVC were enrolled and a 1∶1 matched case-control study was conducted considering age and gender. Thirty PVC cases undergone RMN-guided ablations(RMN group) and 30 PVC cases receiving traditional AAD were controls(drug group). According to the difference of origin, each group was further divided into two sub-groups, which was left ventricular outflow tract(LVOT) group and non-LVOT group. In the RMN group, the catheter ablation was guided by combination of RMN system and Carto 3D mapping system. In the drug group, at least one of Ⅰ-Ⅳ AAD was administrated in patients. The efficacy endpoint was defined as PVC less than 4 000/24 h after treatment. The safety endpoint was defined as the rate of procedure-related complications or drug-related adverse events. Results The success rate of acute ablation was 90% in the RMN group and no significant difference was observed between LVOT and non-LVOT sub-groups(87% vs. 93%, P=1.00). The endpoint analysis showed that the efficacy of the RMN group was significantly higher than that of the drug group(90% vs. 47%, P<0.001). There was no procedure related complication in the RMN group, while there were drug-related adverse events in 2 cases in the drug group(0 vs 7%, P=0.15). Sub-group analysis showed that the effective rates of RMN group in both LVOT and non-LVOT sites were higher than those of the drugs group(P <0.05). Conclusions RMN-guided catheter ablation is more effective than AAD in the reduction of PVC arising from LVOT or non-LVOT and it has similar safety as drug treatment.

关 键 词：磁导航 导管消融 抗心律失常药物 室性期前收缩 

分 类 号：R541.7[医药卫生—心血管疾病]