三维标测系统指导下房室结解剖消融及其对His束起搏参数的影响  

Atrioventricular node anatomical ablation guided by three-dimensional mapping system and the influence on parameters of His bundle pacing

作　　者：孙源君[1] 肖宪杰 于晓红[1] 戴世煜 尹晓盟[1] 高连君[1] 孙伟[1] 张荣峰[1] 王忠振[1] 杨延宗[1] 夏云龙[1] SUN Yuan-jun;XIAO Xian-jie;YU Xiao-hong;DAI Shi-yu;YIN Xiao-meng;GAO Lian-jun;SUN Wei;ZHANG Rong-feng;WANG Zhong-zhen;YANG Yan-zong;XIA Yun-long(Department of Arrhythmia,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,Liaoning,China)

机构地区：[1]大连医科大学附属第一医院心律失常中心,辽宁大连116011

出　　处：《中国心脏起搏与心电生理杂志》2021年第2期139-143,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨三维标测系统指导下,对房室结解剖位置消融及其对His束起搏参数的影响。方法入选房室结消融的永久性心房颤动患者28例,其中7例既往接受了His束起搏,仅行房室结消融(单一消融组),21例同时进行了三维标测系统指导下房室结消融联合His束起搏(联合手术组)。三维标测系统下标测His束、冠状窦口及三尖瓣环,在构建出的Koch三角区域进行消融,实现完全性房室传导阻滞,完全His束起搏。3个月后程控起搏器参数。结果所有患者通过房室结解剖消融均实现完全性房室传导阻滞,消融时间(170.3±14.7)s,术中消融未对His束电极参数产生影响。联合手术组透视时间(7.3±2.7)min,手术时间(102.6±14.9)min。单一消融组透视时间(1.7±0.7)min,手术时间(36.6±5.4)min。术后3个月程控均完全His束起搏,所有患者术后3个月His束电极参数均较前无明显变化。结论三维标测系统指导下房室结解剖消融是安全可行及高效的,且对His束起搏参数未产生影响。Objective To explore the effect and safety of anatomical ablation of atrioventricular node guided by three-dimensional mapping system and the influence on parameters of His bundle pacing.Methods Twenty-eight patients with permanent atrial fibrillation who underwent atrioventricular node ablation were enrolled,including 7 patients who had received His bundle pacing before and just underwent atrioventricular node ablation(single ablation group),and 21 patients who underwent atrioventricular node ablation combined with His bundle pacing(combined operation group)with three-dimensional mapping system.The His bundle,coronary sinus ostium and tricuspid annulus were marked by the three-dimensional mapping system.Ablation was performed in the Koch triangle area to realize complete atrioventricular block and complete His bundle pacing.Pacemaker parameters were programmed after 3 months.Results Complete atrioventricular block was achieved in all patients by anatomical ablation of atrioventricular node.The ablation time was(170.3±14.7)s,and the parameters of His bundle electrode were not affected after ablation.The fluoroscopy time and operation time of combined operation group were(7.3±2.7)min and(102.6±14.9)min,respectively.The fluoroscopy time and operation time of single ablation group were(1.7±0.7)min and(36.6±5.4)min,respectively.At 3 months follow-up,all patients experienced His bundle pacing all the time,and the parameters of His bundle electrode did not change significantly.Conclusion Anatomical ablation of atrioventricular node guided by three-dimensional mapping system is safe,feasible,efficient and has no influence on parameters of His bundle pacing.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(2):139-143]

关 键 词：电生理学 心房颤动 三维标测系统 房室结消融 KOCH三角 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]